ATTACHMENT_A_Change_request_Form.docx
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- Solicitation number
- 0000039486
- Issued by
- California
About this file
This is a Change Request Form template issued by the California Department of Corrections and Rehabilitation (CDCR) in coordination with the California Correctional Health Care Services (CCHCS). The form establishes a standardized process for submitting and managing system changes within CDCR operations. Change requests must be submitted by 3:30 PM on Friday and require email approval from a Supervisor, Manager, or Section Chief before submission to change.control@cdcr.ca.gov. The form accommodates three types of changes: Normal changes for non-standard service modifications; Standard changes utilizing pre-approved models requiring annual authorization in January; and Emergency changes requiring immediate action due to significant business impact. Requesters must complete multiple sections documenting change identification, scope and impact assessment, affected system components, application deployment details if applicable, communication and notification requirements, implementation and contingency plans, and decommissioning activities when relevant.
The form requires comprehensive documentation including hardware, software, network, and environmental impacts; identification of affected agencies, units, and locations; customer downtime assessment; and Service Desk impact evaluation. Submitters must attach supporting documents such as plans and service bulletins and indicate whether customer approvals are complete and if Daily Bulletin posting is necessary. The form includes provisions for SolarWinds Network Management requests to mute or unmanage affected nodes and requires detailed implementation, rollback, and remediation plans. For decommissioning activities, stakeholders, existing users, and the Technical Enterprise Architect must be notified prior to implementation. Upon completion, requesters must email confirmation to change.control@cdcr.ca.gov with completion date and any issues encountered.
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Text version
Deadline to Submit Change Request: 3:30 PM Friday Management Approvals: Emailed approval from the Supervisor, Manager or Section Chief is required.
Required Documents: Submitter must attach documents (plans, Service Bulletin, etc.) with the Change Request and email the Change Request package to change.control@cdcr.ca.gov.
This section to be completed by the Change Control Manager Change No.: ___________________ Date Submitted: __/__/____ Hearing Date: __/__/____
| SECTION A – IDENTIFICATION & CHANGE DESCRIPTION | Help | ||||||||||||||
| Change Title | _________________________________________________________________________ | ||||||||||||||
| Start Date and Time | __/__/____ __:__ | Change Request Calendar | |||||||||||||
| End Date and Time | __/__/____ __:__ | ||||||||||||||
| Originating Agency | ☐ CDCR ☐ CCHCS ☐ Other, specify ___________________________________ | ||||||||||||||
| Requesting Unit | _________________________________________________________________________ | ||||||||||||||
| Submitter’s Name | _________________________________________________________________________ | ||||||||||||||
| Requester’s Contact | Desk (___) ___-____ | Mobile (___) ___-____ | Email __________________________________________________________________ | ||||||||||||
| Reference No. | _____________________________ | (Ticket No., CR No., PCR No., RFC No., Prior CCB No. or project name) | |||||||||||||
| ☐ Normal | Any service change that is not a standard or emergency change. Most change requests will fall into this category. | ||||||||||||||
| ☐ Standard | A Standard change is one that utilizes a proven Change Model that allows the change to be pre-approved or pre-authorized. Standard changes require an annual approval each January. Attach an annual calendar for reoccurring events. For additional information on Standard requests, refer to Help. | ||||||||||||||
| ☐ Emergency | Immediate action required. Business operations will be significantly impacted due to service disruptions or outages. | ||||||||||||||
| Change Description | ______________________________________________________________________________________________________________________________________________________________________________________________________________________________ | ||||||||||||||
| Non-Technical Description for the Customer | ______________________________________________________________________________________________________________________________________________________________________________________________________________________________ | ||||||||||||||
| SECTION B - SCOPE & IMPACT | Help | ||||||||||||||
| Security Impact | ☐ No ☐ Yes, specify ______________________________________________________ | ||||||||||||||
| Agencies Impacted | ☐ CDCR ☐ CCHCS ☐ Other, specify ________________________________________ | ||||||||||||||
| Units Impacted | ____________________________________________________________________ | ||||||||||||||
| Locations Impacted | ____________________________________________________________________ | ||||||||||||||
| Is there expected downtime for the customer? ☐ No ☐ Not expected ☐ Yes | If yes, please provide a brief description (or submit a more lengthy description) for the customer, explaining what impact they may expect. | _________________________________________________________________________________________ | |||||||||||||
| How will this change impact the Service Desk (i.e., Increased customer calls, tickets, support, training and etc.)? | Please explain ___________________________________________________________________________________ | ||||||||||||||
| SECTION C - AFFECTED COMPONENTS (Attach additional pages as necessary.) | Help | ||||||||||||||
| ☐ Hardware __________________________________ | ☐ Server(s) ___________________________________ | ☐ Workstations, count: _________ | ☐ Storage ____________________________________ | ☐ Operating System(s) __________________________ | ☐ Application(s) _______________________________ | ☐ Databases __________________________________ | ☐ File(s) ______________________________________ | ☐ Job(s) _____________________________________ | ☐ Communication (PBX, EG, Radio, etc.) | _____________________________________________ | ☐ Network (routers, switches, VLAN, etc.) | _____________________________________________ | ☐ Environmental (power, etc.) | _____________________________________________ | ☐ Other ______________________________________ |
| SECTION D - APPLICATION DEPLOYMENT | Help | ||||||||||||||
| Is this an update to an existing application or is it a new application? ☐ Update ☐ New ☐ N/A | (If N/A, skip to Section E.) | What is the method of distribution (i.e., SCCM)? _________________________ | What is the size of the deployment package? ____________ | What date and time is the application being deployed? Click or tap to enter a date. | |||||||||||
| SECTION E – COMMUNICATION | Help | ||||||||||||||
| Are customer approvals complete? ☐ No, explain ☐ Yes | ___________________________________________________________________________________________Is a Service Bulletin required? ☐ No ☐ Yes Service Bulletin Requests must be sent to ITSC along with this Request for Change in order for it to be processed. | Will this change need to be added to the Daily Bulletin? ☐ No ☐ Yes | A posting on the Daily Bulletin is required if the work has potential to noticeably impact customers/users. | A list of impacted nodes (servers, network devices, applications, etc.) is required to be submitted with this Change Request. If this work will cause alerts in SolarWinds, please provide the ticket number and indicate if these nodes should be unmanaged or muted. Ticket #__________________ SolarWinds Network Management Requests | ☐ Un-managed ☐ Muted ☐ N/A | Explain (yes or no): __________________________________________________________________________________________ | |||||||||
| Ticket No.: _______________________ | Assigned to: ________________________________ | ||||||||||||||
| SECTION F - IMPLEMENTATION & CONTINGENCY PLANS | Help | ||||||||||||||
| Is there an Implementation plan? ☐ No, explain ☐ Yes, attach plan | __________________________________________________________________________________________ | What is the Rollback and/or Remediation Plan? (Attach additional documents, as required.) | __________________________________________________________________________________________ |
| SECTION G – DECOMMISIONING ACTIVITIES | Help | |||||||
| Is this change related to a decommissioning activity? ☐ Yes ☐ No | If Yes, complete this section. If No, skip to Section H. | For all change requests related to decommissioning activities, please confirm that the following has been or will be completed prior to the start date: | Stakeholders have been/will be notified of any planned decommissioning activity. ☐ Yes ☐ No, explain | _____________________________________________________________________________________________ | Existing users have been/will be notified of the decommissioning schedule. ☐ Yes ☐ No, explain | _____________________________________________________________________________________________ | The Technical (Enterprise) Architect has been/will be notified of any planned decommissioning so related software / hardware can be evaluated for lifecycle change. ☐ Yes ☐ No, explain | _____________________________________________________________________________________________ |
| SECTION H - CLOSE OUT | Help | |||||||
| Once the change has been completed, please email change.control@cdcr.ca.gov to confirm completion. Please include when the change was completed and any issues that may have occurred. |
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