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CONSTRUCTION CHANGE ORDER REQUEST
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Request Control
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Request Number
Revision Number
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Request Status
Request Type
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PriorityProject Name
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Project Number
Contract Reference
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Site Address
Customer Name
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Main Contractor Name
Subcontractor Name
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Subcontract Reference
Purchase-order Number
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Work-order Number
Estimate Reference
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Cost CodeTrade
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Work PackageProject Phase
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Building / Floor / Zone
Submitted To
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Dates and Instruction
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Requested ByPrepared By
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Reviewed ByRequest Date
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Submission Date
Required Response Date
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Pricing Valid Until
Instruction Date
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Instruction Received From
Instruction Type
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Scope and Commercial Basis
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Reason for Change
Change Description
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Original Scope
Proposed Revised Scope
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Scope Addition
Scope Omission
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Scope Substitution
Assumptions
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Exclusions
Access Requirements
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Procurement Impact
Supporting References
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Pricing and Contract Impact
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Direct Cost Subtotal
Overhead / Profit / Bond / Insurance
Tax Amount
Proposed Addition
Proposed Deduction
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Net Proposed Adjustment
Original Contract Value
Current Approved Change Value
Current Revised Contract Value
Proposed Revised Contract Value
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---
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Schedule and Approval
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Schedule Impact
Additional Days Requested
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Days Saved
Net Schedule Adjustment
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Original Completion Date
Current Completion Date
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Proposed Completion Date
Approval Status
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ReviewerReview Date
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Approved Amount
Approved Time Adjustment
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Approved Completion Date
Approved Change-order Number
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Converted Status
Conversion Date
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Supporting Documents and Comments
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Supporting-document Status
Attachment Checklist
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Customer Comments
Review Comments
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Rejection / Withdrawal Reason
Internal Notes
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