REQUEST FOR CHANGE FORM(RFC FORM)

Change Request Number: Date of Submission Requestor For Backup contact

RFC Person submitting the RFC Requestor's name if not self Enter BACKUP'S name Phone: (000)000-0000 Phone: (000)000-0000 Phone: (000)000-0000

All fields must be filled out completely. Incomplete RFCs will be returned. Does the entire change stand on its own? If there is an implementation plan, can some of the steps be implemented or backed out together? If some steps can remain though others fail, the Request for Change (RFC) should be broken down into individual RFCs. Field 1: Brief Description (80 chars max) Field 2: Detailed Description What the change is intended to accomplish, why it is necessary, and what will happen if the change is NOT executed. (80 Chars max) Field 3: Type of Change Check all subsystems that apply Type of Subsystem Host Network Storage Application Database Environment/ Facilities Firewalls (attach Firewall RFC Form) OTHER - describe subsystem Hardware Software Config Setup

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Field 4: Reason for Change Check all that apply TITLE Maintenance Capacity Functionality /Service Testing Security Other (Identify) Reason Preventative Install New Functionality Preventive Reason Corrective Upgrade Expanded Stress Corrective Reason Other Swap/Reconfig Obsolete Recovery Other

Field 5: Potential Impacts Describe overall impact: Known/ Best Case Impacts Production Stage Development Test Internet/External Field 6: Production Outages: Expected duration Hours: Minutes: Worst Case Impacts Affected Location And/or Service Name

Field 7: Affected Host Names and Applications Host Name Application

Field 8: Change Type Select one. Normal Standard - Pre-Authorized (Original Change Request Number - RFC Emergency Information Only )

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Field 9: Schedule Information Implementation Group/ Representative Day, Date Time of Day Duration of Implementation Target Date(s) Alternate Date(s) Implementation Location Related or Pre-requisite change activities:

: Days

AM Hours

PM Minutes

Field 10: Implementation Steps What steps are required to implement the change? 1. 2. 3. 4. 4)... (if necessary) Field 11: Affected Documentation What databases or documentation need to be updated prior to the completion of this change?

Field 12: Is this an Emergency Change? Yes No If this is an Emergency Change, can the change be backed out in its entirety? Or, is a partial back-out possible? Back-out Plan provided? If this is an Emergency Change, please explain the emergency. Field 13: Acceptance Criteria What tests will be used to confirm successful implementation? Test Describe

Field 14: Backout Contingency Plan If the acceptance criteria are not met, what steps will be performed to backout the change? 1. 2. 3. 4.

(if needed)

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Field 15: Backout Criteria When the backout steps are performed, what tests will be used to confirm successful backout? Test Describe

Field 16: Escalation Plan If the backout criteria are not met, what method will be used to escalate and resolve the problem? 1. 2. 3. 4. (if necessary) Field 17: Other Considerations/Issues Prior History Special notification or visibility Helpdesk symptoms or concerns Field 18: CMDB Which Configuration Items (CIs) have been updated? Configuration Item (CI) Name(s) and related Information: Field 19: Related Request for Change Is this change related to other RFCs? Please provide related RFC numbers:

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Field 20: Change Advisory Board Approvals Problem Management Yes No Comments: Configuration Management Yes No Comments: Change Management Yes No Comments: Operations Management Yes No Comments: Security Management Yes No Comments: System Owner Yes No Comments: Others as Required Yes No Comments:

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