Use this Certa Change Request template to plan, justify, and control operational changes across departments. Capture the change title, request date, preparer, version, and location. Define the case for change, type (plant, equipment, process, technology, procedural, organizational, people), and whether it is temporary or permanent. Provide a detailed description and justification, anticipated start date, and potential hazards if the change is not implemented. Identify required control measures and additional resources, note any asset replacements, and list affected stakeholders. Record notifications, benefits and adverse effects for stakeholders, staff, and operations. Add actions with owners and due dates, link to supporting systems, select the responsible department, and obtain director approval and signature before implementation.
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