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Inspection

[This form is divided into three sections. Section 1 is intended for use by the individual submitting the change request. Section 2 is intended for use by the Project Manager to document/communicate their initial impact analysis of the requested change. Section 3 is intended for use by the Change Control Board (CCB) to document their final decision regarding the requested change.]

SUBMITTER - General Information

Brief description of request (Enter detailed description of the change being requested)

Priority level

Reason for change

Take photo evidence of item/areas affected and needed to modify

Assumptions and notes regarding the requested change

Name & Signature of Submitter
PROJECT MANAGER - Initial Analysis

Hour impact

Duration impact

Schedule impact

Attachments or references (i.e ., photos of drawings, specifications, schedule etc)

List down estimated cost of labor and the necessary materials needed

Name & Signature of Project Manager
CHANGE CONTROL BOARD - Decision
Decision

Specify Conditions

Decision Date & Time
Approval Signature

Change Order Form Template Checklist

Created by: SafetyCulture Staff | Industry: General | Downloads: 6

Use this change order form template for requesting, approving and documenting alterations to the project. This template is divided into three sections intended for: individual submitting the change request, project manager communicating their initial impact analysis of requested change and Change Control Board (CCB) to document final decision.

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Inspection

[This form is divided into three sections. Section 1 is intended for use by the individual submitting the change request. Section 2 is intended for use by the Project Manager to document/communicate their initial impact analysis of the requested change. Section 3 is intended for use by the Change Control Board (CCB) to document their final decision regarding the requested change.]

SUBMITTER - General Information

Brief description of request (Enter detailed description of the change being requested)

Priority level

Reason for change

Take photo evidence of item/areas affected and needed to modify

Assumptions and notes regarding the requested change

Name & Signature of Submitter
PROJECT MANAGER - Initial Analysis

Hour impact

Duration impact

Schedule impact

Attachments or references (i.e ., photos of drawings, specifications, schedule etc)

List down estimated cost of labor and the necessary materials needed

Name & Signature of Project Manager
CHANGE CONTROL BOARD - Decision
Decision

Specify Conditions

Decision Date & Time
Approval Signature