IT DEPARTMENT

SERVICE REQUEST FORM

SECTION 1: TO BE FILLED BY REQUESTING DEPARTMENT
SERVICE REQUEST SUMMARY
Requested by Department Dispatch No.
Subject
Application / Module Name
Prepared by Reviewed by Approved by
Name
Designation
Email
Contact No.
Signature

SERVICE REQUEST DETAILS

Project/Program/Initiative Ref.
Detail description of service
Reason for service request
Envisaged Benefits
Possible business impact Citizen services Requesting dept. only Multi dept
Priority Low Medium High Urgent
Reason for assigned priority
Supporting attachments or
References (MoM, Circulars,
etc)

SECTION 2: TO BE FILLED BY IT DEPARTMENT (IN CONSULTATION WITH USER, VENDOR & CONSULTANT)
Service request type Incident Enhancement Project SR #
PRELIMINARY IMPACT ANALYSIS

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 IT DEPARTMENT
SERVICE REQUEST FORM
Process Functional IT System
Human Resources IT Dept. | Other Depts. | Consultant | Vendor | Any other
Specify details
Infra Client side | Server side | Network
Specify details
Security Physical | Network | System
Specify details
Commercial
Schedule dependencies with IT dept | Vendor | Previous SR
Specify details
Artifacts (Circular, Manuals,Specify details
etc)
Other (if any) Specify details
Assumptions for
recommendations
High level recommendations (Advantages, Disadvantages, Effort estimate, Alternative)
to mitigate impact
Prepared by Reviewed by Approved by
Name
Designation
Email
Contact No.
Signature

Section 3
CHANGE CONTROL BOARD – DECISION
Pending CR Status Urgent High Medium Low
Decision Approved Rejected More Info
Approved with Conditions
Conditions
Rejection
Proposed way forward /
Implementation
Assigned priority
Approving Authority Signature with Designation
date
Approving Authority Signature with Designation
date
Approving Authority Signature with Designation
date

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