Reporter Name: 
Reporter Phone: 
Reporter Dept: 
Reporter Email: 

Requester:
Phone:
Email:
Product/service name:
System/server name:
Requested Start Date:
Required By Date:
Description of Change:

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This should be a complete explanation of what is happening in the change.
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Reason for Change:
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Explain why the change is needed and if it is related to a problem ensure the IR # (Incident Record) is filled in.
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Configuration Item (CI) Affected:

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To what is the change being applied (for example: server, desktop, software, documentation, etc.)?
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CI Relationship:

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Who (users/groups) or what (server/desktop/documentation, etc.) is being impacted by this change?
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Communication Strategy:

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Is there a communication strategy in place for notifying the users and clients if they are impacted (i.e. weekly or special communiqué)?
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Test Plan to ensure successful change:

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How was this change tested in the test environment to ensure there would not be a problem during the implementation? How was this change tested in the production environment to ensure there would not be a problem after implementation? Any special implementation instructions should be included here as well..
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Back Out/Recovery Plan:


If a problem should occur, what is the plan to reverse the change?

Is this change being performed during the maintenance window?:

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Can the change be implemented during a maintenance window (which maintenance window) and if not why?
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Is there an outage?:

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During the change, is there a time when the user cannot access a system?
If so, for how long? What is the delivery mechanism being used (NAL object (force run), CD, Thin client)? How many users impacted? Is a reboot required for any workstation and/or server?
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Impact Risk Assessment:

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What is the risk of doing the change? What is the risk of not doing the change? Make certain all CIs impacted are addressed.
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Other Pertinent Information:

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Who is to be contacted once the work is completed (Service Desk, GOP MIC (Ops DM), Partner Support Groups managing affected Systems)? Who is the OPI for this Project? What is the minimum number of days for vendor cancellation at no cost to the Crown?
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