1. Project Name] Project – Change Request Summary
[Note: Hints & Tips are provided through out this template & are shown in blue italic. Please delete these when you no longer require them, and in advance of submitting for approval consideration.]
Project ID : [Project ID Number – as provided by PMO]
Short Name: [Project Name]
Department/ School/ Faculty: [Department / School / Faculty Name]
Dean/ Chief Officer approver: [Name & Title of approver]
Project Sponsor: [Sponsor Name / Role in TCD]
EOG Champion: [EOG Champion Name / role in TCD]
Project Manager: [Name, role in TCD ]
Project Type/ Category: [Operational/ Change Management/ Legislative/ External/ New Build /Refurbishment /IT / Audio Visual / Infrastructure]
Level of Funding Secured: [€€€ - total of funding secured as per Financial Plan or Funding Model]
Total Project Cost: [€€€ –total project cost approved in principle OR Estimate as per Financial Plan]
Approved Project Spend (Current Baseline): [€€€ Total Project Spend Approved to date as per Financial Plan]
Additional Spend Sought: [€€€€ – to get to Stage Gate[?]]
Document Version [e.g V0.1 must match filename]
Issued Date: [ DD/MM/YY]
Prior sign off, Review and Information Prior to submission into the approval & prioritisation process, key stakeholders in other business areas directly involved in delivery of this proposal or on whom the project is dependent, should review or approve this submission primarily from the perspective of their relevant business area / project role.
[Note: Please review the table below & complete / update / delete key stakeholder details, as appropriate for your project]
Key stakeholder/Dependency area
Role
Action
Review Date
Finance Rep / Contact name
Verify Financial plan and Funding details
Approve
 DD/MM/YY
ISS Rep / Contact name
Verify IS costs
E & F Rep / Contact name
Verify E & F costs
Disability Services Rep / Contact name
HR Partner / Contact name
Review
Space Allocation

2. [Project Short Name] Change Request
Decision / Approval sought from Steering Committee / CRG:
To approve project Change Request [CR ID e.g. CR01] to:
[Note: Describe Change Request e.g. increase/decrease to budget, scope, project resources etc. Change Request description can be taken from Change Request Log].
Xxx
xxx
Project Objectives / Purpose
Key Projects Objectives are :-
[Note: Provide a brief overview of project objectives/ purpose including information on timeline for delivery, quality to be met risk and benefit performance goals - What is this project trying to achieve. This can be taken from the business case.]
Xxx

3. [Project Short Name] Change Request
[Note: This slide should outline the potential solution options considered.]
Option 1
Option 2
[Note:Include brief Summary of Option 1]
Option 1 involves…..
Pros:
[Note: List the advantages linked to implementation of Option 1]
Advantage 1
Advantage 2
Advantage 3
Cons:
[Note: List the disadvantages linked to implementation of Option 1]
Disadvantage 1
Disadvantage 2
Disadvantage 3
[Note:Include brief Summary of Option 2]
Option 2 involves…..
[Note: List the advantages linked to implementation of Option 2]
[Note: List the disadvantages linked to implementation of Option 2]

4. [Project Short Name] Change Request
Recommendation - Go with Option x
[Note: This slide should identify the recommended solution and provide clear reasons on why it is being put forward for Steering Committee approval.]
The recommendation is to select Solution X, because
Xxx
xxx
Reasons:
[List the recommendations and reasons for putting forward Option x]
Reason 1
Reason 2
Reason 3

5. [Project Short Name] Change Request Impacts
[Note: Project Team provides observations of potential impacts at a project/programme level in terms of risks, assumptions and dependencies.]
The project team has made the following observations / assessments regarding the impacts of the changes requested :-
Overall project impacts
Xxx
Benefits/Funding Model impacts:
Timeline impacts:
Overall timeline increased by xx man days
Financial impacts:
Resource impacts:
Scope impacts:
Quality impacts:

6. [Project Short Name] Project Roadmap
[Note: Include Project Roadmap; the chart should illustrate planned vs actual – where is the project in terms of milestones/deliverables compared to where it is planned to be]
[Project Name] Roadmap
Year
2014
2015
2016
Month
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Qtr Q4 Q1 Q2 Q3
Project Milestones/Deliverables
Status
Pre-Approval G
Initiation & Strategic Planning
Initiation & Str Planning
Detailed Planning & High Level Design
Detailed Design (Current Stage) A
Detailed Design
Execution & Handover
Tender (Next Stage)
Tender
Execution
Testing
Handover & Implementation
Closeout
Post Project
Post-Project
Slippage accrued impacting timeline. Request to carry over key deliverables to Next Stage (Tender Stage).
Outstanding Key Deliverables from Current Stage to be completed here ensuring timeline is achieved as per approved baseline
REPLACE WITH APPROPRIATE INFO
Current Stage
Next Stage

7. [Project Name] Outstanding Key Deliverables
[Note: Include a status of key deliverables outstanding on the project]
Deliverables
Deliverable Status
Due Date
Action Owner
Actions To Close
Deliverable 1
Awaiting Approval
Xxx
Deliverable 2
Deferred
Deliverable 3
Deliverable 4
[List key deliverables outstanding on the Project, refer to Project Delivery Plan (WIP)]
[Awaiting Approval/On Hold/Deferred/No longer required/In Progress]
[dd/mm/yy]
[Name of action owner of deliverable]
[Provide any actions to close in order to get to/achieve an approved deliverable status]
REPLACE WITH APPROPRIATE INFO

8. [Project Name] Benefits/Funding Model
Note: Example of Benefits Model include best case and worst case scenarios/ Increases in student/researcher numbers which result in worst and best case income generation.
Please insert key Benefits/Funding Model as agreed with FSD/ Finance Partner. Example of extract from Financial Plan
REPLACE WITH APPROPRIATE INFO
Notes on Finanicals/Benefits:
CRG require confirmation that funding and approval to proceed (by Dean/Chief Officer) is in place before approval is sought via Governance/CRG.
Fund Raising/ Payback/ROI details to be provided.

9. [Project Short Name] Financial Performance
[Note: See more detailed project information from latest Finance Plan (Appendix B)]
Project Stage/Description
Approved (€000)
Date Approved (dd/mm/yy)
Approval By
Actual/ Committed Spend
(€000)
Variance (€000)
+/-
Comments
Total Project Cost (Approved in principle OR Estimate)
€xxx
DD/MM/YY
CRG/EOG/Board
Approval & Prioritisation (Gate 0)
CRG
€€€ approved to Gate 3
Initiation & Strategic Planning (Gate 1)
Change Request €x
Detailed Planning & High Level Design (Gate 2)
Detailed Design (Current Stage) (Gate 3)
SPEND TO DATE
Tender (Execution & Handover )- Next Stage (Gate 4)
€xx
Execution (Execution & Handover ) (Gate 5)
Closeout (Gate 6)
Post Project
€ Additional Spend Sought
€ Proposed Project Spend/ Seeking Approval (Future Baseline) - VAT Inclusive
REPLACE WITH APPROPRIATE INFO

10. [Project Name] Project Cost Baseline (summary)
[Note: Include Summary Details from Project Financial Plan; additional information may also be included (graphs, numbers)]
REPLACE WITH APPROPRIATE INFO
Financial Performance Notes:
Note 1: €€€€€ includes 5% retention cost.
Note 2: Baseline cost estimated at MMYYYY CRG of €€€; actual cost post tender confirmed as €€€

11. [Project Name] On-going Operational Costs
[Note: Include On-going Costs Details from Project Financial Plan]
REPLACE WITH APPROPRIATE INFO

12. Risks, Assumptions, Issues, Dependencies Requiring Attention
[Note: Use RAID log to assist when completing Key Risks/Issues below]
Prty No.
RAG
Status
Description
Potential Impact
Avoidance/Mitigation Action
Risk Owner
Action by
Date Closed
R01
00002
Open
Planning permission will not be granted
Project will not meet delivery date
ensure contingency in schedule for planning
Project Manager 
A01
Assumption ROI will be met in agreed timeframe
College loan will not be paid back in agreed time
Monitor ROI forecast during project & post project
Sponsor
D01
Dependency on internal completion of Project Z prior to delivery
Impact on capital projects portfolio
Monitor delivery/project schedule of project Z to ensure it does not delay impact on approved schedule
PMO/Sponsor
[Risk ID as per RAID log ]
[Provide the RAG status of the risk]
[Provide a brief description of the key risk as identified in RAID log]
[State the recommended mitigation strategy to manage the risk]
[Provide owner as per RAID log]
Resolution date
actual date closed
[assumption ID as per RAID log]
[Provide the RAG status]
[Provide a brief description of the assumption identified in RAID log]
[State the recommended mitigation strategy to manage the assumption]
[Provide owner as per RAID log]
[Issue ID as per RAID log ]
[Provide the RAG status of the issue]
[Provide a brief description of the key issue as identified in RAID log]
[State the recommended mitigation strategy to manage the issue]
[Dependency ID as per RAID log ]
[State the recommended mitigation strategy to manage the dependency]

13. [Project Short Name] Change Request Appendices
Project Risk Indicator (PRI)
Status Report
Change request log (if appropriate)
Include Relevant Additional Project Financial Information(e.g. from updated Financial Plan)
[Include other additional information / detail that might support your proposal]

14. [Project Short Name] Project Risk Indicator
[Note: The PRI log below captures a risk indicator (Low, Medium, High) of the project to date]
Project Risk Indicator
Very Low (1)
Low (2)
Medium (3)
High (4)
Very High (5)
Score (Current Stage)
Score
(Change Impact)
Team size
<3
3-7
8-12
13-17
>17
# of cross functional areas involved
01-Feb
3-4
5-7
8-10
>10
Estimated Duration (Elapsed Months)
< 4
4-11
12-18
19-24
>24
Technology and / or Business Process – Known or New
In house expertise
Very Familiar
Somewhat Familiar
New to TCD
New to industry/ Leading edge
Complexity of solution
Well defined. No problems expected
Known. Some minor problems expected
Known but some medium / major problems expected
More than 1 approach available
Solution unknown or vaguely defined
Dependency on external suppliers / organisations
Long standing
Reasonable relationship
Used before, but not regularly
Used before, but not recently
No previous relationship
Risk to Reputation
Reputational risk Unlikely to happen, Negligible impact
Reputational risks occasionally occur, Minor impact to reputation
Reputational risks are likely as not to occur, Notable impact to reputation
Reputational risks are likely to occur, Substantial impact to reputation if they do
Reputational risks certain to occur, Threatens the reputation of the project or TCD
TCD/External Resource Impact
In house skills present and project is easily absorbed within current workload
In house skills present with some occasional impact on current workloads
In house skills present but the project will impact current workloads and require backfill
Up skilling required, resources will be dedicated to the project, or may require external resources
In house and external resources dedicated to the project and from more than one department
Funding/Finance
Funding exists with current budgets
Most Funding in place or requires minor budgetary allocation
Funds not in place. Project will impact departmental budgets
Funding sources not clear, will impact TCD budgets
Funding will be difficult, funding complexity mix high and possibly not attainable
Project Scoring:
Low Medium High
<19 19 – 31 > 32
The Project Scoring of the Current Stage as submitted and approved
(Please also indicate whether Low, Medium, High)

15. [Project Short Name] Change Requests Log
[Note: Include upcoming CRs for next stage of project]
Change Request
(Provide ID from CR log)
CR Description
CR Owner
Impacts on Project
[List the IDs where a CR has been issued]
[Provide a brief description of the CR (see CR log) e.g. increase/decrease to budget, scope, project resources etc…]
[Person/college area seeking approval of CR]
[Provide a brief description on the areas the CR will impact]
[budget
Scope
Resource
Quality]
CR03
Xxx