Example Change Control Package cont'd

DOE-STD-1073-2003

Configuration Management

10.

Affected SSCs: (List the SSCs affected by the proposed change. Identify their classification

levels. Reference their documented design requirements. See item 3 above for classification

levels. Use continuation sheets as necessary)__________________________________________

______________________________________________________________________________

11.

Are there design changes associated with the proposed change?

[ ] yes [ ]no

If yes, complete item 12.

12.

Design review complete and attached or referenced: [Verifies that all SSCs involved in or

affected by the change have been identified (and properly classified where appropriate), that the

requirements for SSCs have been documented, that appropriate reference documents are listed, and the

design criteria are listed.]

[ ] yes

13.

Independent verification complete?

[ ] yes

14.

Interdisciplinary review of proposed change complete?

[ ] yes

15.

Will the change significantly degrade safety or negatively impact adequate protection of

workers, the environment, or the public? [ ] no [ ] yes, and proposed change is rejected.

16.

Identify the requirements and standards that apply to the change. (attach list)

Management Review

17.

Was the technical review adequately performed? (adequately performed according to review

procedures)

[ ] yes

[ ]no, return for completion

18.

The work control package is complete, ready for implementation, and attached?

[ ] yes

19.

The necessary approvals have been obtained and are attached.

[ ] yes

20.

Identify the source(s) of funding to implement the change and update the documentation.

_______________________________________________________________________________

21.

Is the change necessary, and if so, why?

_______________________________________________________________________________

22.

Do the benefits of the change warrant the costs?

[ ] yes

USQ Review Questions

23.

Is a USQ review required for the proposed change?

[ ] yes [ ] no

24.

If yes, has the USQ review been completed?

[ ] yes

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