QMS Change Request Form [PDF]

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Click here to buy toolkit now Change Request Form



TOP THREE CONCEPT



Change Request Form Change statement



XXXXXX



Change Sponsor’s name & signature Date of Request



Requester/initiator



Person submitting the change request



Change ID Number



001



(must match Change Log entry)



Implementation by:



Change Request Detail - The Change Request form is the document of record for a change request. Type(s) of Change: Strategic direction



People



Policy



Supplier/Supplies



Project /production plan



ICT/machine parts



Process/Procedure/Documentation



Contract/orders



Product design/specification



Regulatory Requirement



Organizational structure



Other (please state):



Description of the change requested and rationale:



Priority: 1 – Critical: “I can’t move forward until this change is resolved.” 2 – High: “I’m fine for right now, but unless this change is resolved by the due date, I won’t be able to move forward.” 3 – Normal: “I’m fine for the right now, but this may impact my ability to move forward in the near future.” 4 – Low: “This change is not impacting my ability to move forward.”



Change duration:



Proposed Start date:



Proposed End date:



Benefits of Proposed Change (The additional benefits the



Alternatives (List any alternatives/work-around to the change that exist):



proposed change would have):



Impact Severity 1 - Critical Impact: Requires normal operations shut down 2 - High Impact: Significant disruption to operation schedule, cost, or quality



3 - Normal Impact: Operations disrupted with manageable extensions to schedule and costs 4 - Low Impact: Exposure is minimal to zero



Risk/Impact area & severity (e.g: CHANGE WILL CAUSE STOPAGE OF XYZ PLANT FOR APPROXIMATELY 15 HOURS) : 1.



Control/mitigation plan: (e.g: REPLAN PRODUCTION SCHEDULES TO CATER FOR BACKLOG)



2. 3. 4. 5. Does change affect allocation/reallocation of responsibilities and authorities? Yes No Resources Required for Change: Financial Impact ($) Estimated Cost of the Change: 1



Top Three’s Change Request Form



Describe how?



Change Request Form



TOP THREE CONCEPT



Click here to buy toolkit now Change tracking method (time monitoring, periodic



Change evaluation frequency:



testing, audit, inspection, verifications; data collection, collation, analysis & reporting ) and frequency:



Reviewed by:



Authorization Who has the authority to approve this type of change?



Name



Date



Signature



Approved by:



Advisory Board Steering Committee Executive Sponsor



Business Office Customer/Stakeholder Other:



Change Requests Status Change Request Open Change Request Approved



Name



Date



Signature



Change Request Rejected Change Request Closed



Fiscal Review and Approval by If funding is sourced separately by a department



Deferred for review at later date



Name



Date



2



Signature



Top Three’s Change Request Form



Date: