Change Request Form Template

This Change Request Form (the “Form”) is submitted by [Requester Name] on [Submission Date].

1. Change Overview

1.1 Change Title. [Short title].
1.2 Change Type.
☐ Standard change (planned)
☐ Emergency change (urgent)
☐ Normal change (requires review)
☐ Other: [Type]
1.3 Department/Team. [Team].
1.4 Requested By. [Name/Role].
1.5 Owner/Implementer. [Name/Role].
1.6 Requested Implementation Date. [Date/Time].
1.7 Maintenance Window (If Any). [Window].
1.8 Systems/Services Affected. [List].
1.9 Environment. ☐ Production ☐ Staging ☐ Dev ☐ Other: [Env].

2. Change Description and Justification

2.1 Description. [Explain what will change in plain language].
2.2 Business Justification. [Why the change is needed].
2.3 Expected Benefit. [Performance, security, cost savings, compliance, etc.].
2.4 Impact if Not Implemented. [Risks or costs of not doing it].
2.5 Dependencies. [Teams, vendors, systems, releases].

3. Risk and Impact Assessment

3.1 Customer Impact. ☐ None ☐ Low ☐ Medium ☐ High. Details: [Describe].
3.2 Availability Impact. ☐ None ☐ Degraded performance ☐ Downtime expected. Duration: [Estimate].
3.3 Security Impact. ☐ None ☐ Improves security ☐ Potential risk. Details: [Describe].
3.4 Data Impact. ☐ None ☐ Potential data changes ☐ Backup required. Details: [Describe].
3.5 Compliance/Legal Impact. ☐ None ☐ Review required. Details: [Describe].
3.6 Overall Risk Rating. ☐ Low ☐ Medium ☐ High.

4. Testing and Validation

4.1 Testing Plan. [Tests to be performed before change].
4.2 Validation Plan. [How you will confirm change success].
4.3 Success Criteria. [Clear measurable outcomes].
4.4 Approvals for Testing (Optional). [Who must approve test results].

5. Implementation Plan

5.1 Implementation Steps.

• Step 1: [Action]

• Step 2: [Action]

• Step 3: [Action]
  5.2 Implementation Start/End Time. [Start] to [End].
  5.3 Responsible Parties. [Names/roles].
  5.4 Communication Plan. Internal/external notice required: ☐ Yes ☐ No. If yes: [Channels and audience].

6. Rollback Plan

6.1 Rollback Trigger. [What conditions trigger rollback].
6.2 Rollback Steps.

• Step 1: [Action]

• Step 2: [Action]

• Step 3: [Action]
  6.3 Rollback Owner. [Name/Role].
  6.4 Data Recovery Plan (If Applicable). [Backups, restore steps].

7. Approvals

7.1 Required Approvals.
☐ Engineering/IT
☐ Security
☐ Compliance/Legal
☐ Product/Business owner
☐ Customer support (if customer impact)
☐ Other: [Role]
7.2 Approval Decision.
☐ Approved
☐ Approved with conditions: [Conditions]
☐ Not approved
☐ More information needed: [Info]
7.3 Approver Notes. [Notes].

8. Post-Change Review (Optional)

8.1 Completion Status. ☐ Completed ☐ Partially completed ☐ Rolled back ☐ Cancelled.
8.2 Actual Start/End Time. [Start] to [End].
8.3 Issues Observed. [List].
8.4 Follow-Up Tasks. [Tasks, owners, due dates].
8.5 Documentation Updates. [Runbooks, diagrams, CMDB updates].

Signatures

By signing below, the undersigned approve (or acknowledge) this change request as documented above.

Requester: [Name]
Title/Role: [Title]
Date: [Date]
Signature: ___________________________

Change Owner/Implementer: [Name]
Title/Role: [Title]
Date: [Date]
Signature: ___________________________

Approver 1: [Name]
Title/Role: [Title]
Date: [Date]
Signature: ___________________________

Approver 2 (Optional): [Name]
Title/Role: [Title]
Date: [Date]
Signature: ___________________________