Project Change Request

Government of Newfoundland and Labrador

Office of the Chief Information Officer

Corporate Services & Projects: Project Management Office

Project Change Request[1]

Project Number / < DTC Number / Project Manager
Project Name / < Project Name >
Change Request (CR) Number / Work Offer Number(s) / < WO Number >
Change Request Date / < YYYY-MM-DD > / Purchase Order Number(s) / < PO Number >
Change Summary Information
Priority / Low
Medium
High / Current Stage (Estimate Variance Guideline) / Planning for Analysis (100%)
Analysis (75%)
Design (50%)
Execute – Close (15%)
Overall Impact / Minor
Major
Change Request Amount
Cost[2] / Current Stage(s) Cost / Total Project Cost
Baseline / Revised / Baseline / Revised
Total Project Cost Variance (%)
0.0%
< Revised Total Project Cost – Baseline Total Project Cost / Baseline Total Project Cost >
Work Offer Value / Revised Work Offer Value
PO Value / Revised PO Value
Program Fee / Revised Program Fee
Schedule[3] / Current Stage Duration (Months) / Total Project Duration (Months)
Baseline / Revised / Baseline / Revised
< ## > / < ##> / < ## > / < ## >
Total Project Duration Variance (%)
0.0%
< Revised Total Project Duration – Baseline Total Project Duration / Baseline Total Project Duration >
Current Stage End Date / Revised Current Stage End Date
< YYYY-MM-DD > / < YYYY-MM-DD >
Project End Date / Revised Project End Date
< YYYY-MM-DD > / < YYYY-MM-DD >
Scope
Other / Explain
Description / < Describe what is being changed, such as scope, resources etc. >
Justification / < Describe the reason for the change request. >
Impact of Not Implementing / < Describe the impacts of not implementing the change. >

Prepared By

Project Manager
(name) (signature) (date)

Reviewed By

Delivery Manager / Project Change Request is:
Rejected Recommended for Approval Concerns (provide details)
Impact to DM Portfolio Budget:
< Identify the impact to the Budget (e.g. budget transfers) >
(name) (signature) (date)
Director / Rejected Recommended for Approval
< Enter any applicable comments. >
Approved By:
(Approval if no change in total project cost)
(name) (signature) (date)

Approved By

Executive Director
(Approval required when change in total project cost for projects under $500,000) / Approved Rejected
(name) (signature) (date)
Chief Information Officer (CIO)
(Approval required when change in total project cost for projects over $500,000) / Approved Rejected
(name) (signature) (date)

Purchase Order Information

CO

DTC

PO Number

PO Line Previous Amount

PO Line

Adjustment Amount /

PO Line

New Amount

01
01
01
Total Changes
For Corporate Operations Use Only (After approvals)

Posted By

Date

/ < YYYY-MM-DD >

Project Change Request - Vendor

Project Number / < DTC Number > / Project Manager
Project Name / < Project Name >
Change Request (CR) Number / < CR Number > / Work Offer Number(s) / < WO Number >
Change Request Date / < YYYY-MM-DD > / Purchase Order Number(s) / < PO Number >

Resource Changes

For resource changes: Only list the delta changes, such as additional hours, additional resources, substitution of resources etc.

Approved By

Vendor Name
Vendor*
(name) (signature) (date)
*An email from the Vendor, with this document attached, stating their approval of this change request constitutes vendor endorsement.
Important: Store a copy of the email in PPM.

Project Change Request Page1 of 5

Template Version 3.3 2017-12

[1]This template is owned and maintained by the Project Management Office (PMO) of the Office of the Chief Information Officer (OCIO). Direct questions about this template to the

[2]It is recommended that any significant cost estimate variance (regardless of whether it’s above variance guideline) be discussed with the Delivery Director and rationale for project cancellation / continuation be documented appropriately (e.g. Decision Document).

[3]It is recommended that any significant schedule estimate variance (regardless of whether it’s above variance guideline) be discussed with the Delivery Director and rationale for project cancellation / continuation be documented appropriately (e.g. Decision Document).