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Change Management Form Call Ticket No/CR No Emp. No:   Branch Code:     First

Change Management Form

Call Ticket No/CR No

Emp. No:

 

Branch Code:

   

First Name:

 

Last Name:

   

Designation:

 

Department:

   

Change Status

Prepared

Approved

In Progress

Completed

Closed

(

)

       

Type of Change

 

Hardware:

 

Up gradation

Replacement

 

Removal

Software:

 

Up gradation

New Installation

 

Migration

 

Removal

   

Details of Change Request (attach sheet if required)

 

Proposed Change:

Reason for Change:

Activity Start Date & Time

 

Activity End Date and Time

 

Total Time

 

IOS Version

 

Required

Hostname

 

IP

 

Asset Code

 

Switch/Router LAN IP:

 

Switch/Router

 

Priority:

High/Medium/Low

WAN IP:

Implementation Plan (attach sheet is required)

Required down time

 

Backups

 

Technical docs

Passwords required

Other requirement

BA/FM/CNGMN/1.0

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Classified: Internal

Change Management Form Test Environment Details (attach sheet if required)   Testing Required Yes /

Change Management Form

Test Environment Details (attach sheet if required)

 

Testing Required

Yes / No

Tested on Test Environment

Yes / No

Hostname :

 

OS

 

IP :

 

Database:-

 

Database SID :-

 

Does it Require System Shutdown?

Yes / No/NA

Does it Require to take backup of Configuration Data?

Yes / No/NA

Does it have impact on all Bajaj Allianz LAN Segment?

Yes / No/NA

Mention the impact, if applicable

Is it required to amend documentation / inventory?

Yes / No/NA

Does it require Password for/from?

 

Was the change successful?

Yes / No/NA

Problems, if any?

 

Rollback Needed?

Yes / No/NA

Trigger point (Time to start rollback, if any issue during implementation)

 

Rollback Plan / Procedure (Mandatory) (attach sheet if required)

 

Period of Change

Permanent Limited Period If for limited period, tentative date to be removed on DD / MM / YYYY

 

Approved By:

 

Performed By:

 

Checked By:

 

Signature

 

Signature

 

Signature

Name :

Name :

Name :

Date:

DD / MM / YYYY

Date:

DD / MM / YYYY

Date:

DD / MM / YYYY

BA/FM/CNGMN/1.0

 

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Classified: Internal