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✓ <br /> . Y: : <br /> Appendix A - Project change control document <br /> Customer Name: <br /> Burwood Project#: <br /> Request(completed by requester) <br /> Author. <br /> Date of Request: <br /> Change# <br /> TiUe of Change: <br /> Description of Change: <br /> Reason for Change: <br /> Hardware Required: <br /> Software Required: <br /> Action Required: <br /> Target completion date: <br /> Change Requested by: <br /> (Signature) <br /> Impact(completed by Project Manager) <br /> Timeline Impact; <br /> Cost Impact: <br /> Overall Impact: <br /> PM Approval () YES () NO (Tick As App�opriateJ <br /> Recommendation: <br /> PM Comments: <br /> Project Manager: <br /> (Signature) <br /> Instructions:The Request portion o(this(orm is to be completely filled oul by the requester and delivered to the Projecl Manager.The Project <br /> Manager will research the impact on the projec�timeline as well as any cosl or resource impact and complele Ihe Impacl porlion of this form. <br /> The approval authority for the project will then sign the Approval portion before any work can take place and reWm the form to the Project <br /> Manager for action.The Projecl Manager will take appropriale aclion to implement lhe approved Change Request.document!he change in <br /> the Work Rewrd porUon of this form,and make any required adjustments lo the umeline and financials.This completed form will be retained <br /> as part of Ihe permaneni project file. <br /> �`'�����fr,7U[y,;� Confidential and proprie[ary to Burwood Group,Inc. 7 <br />