Design Field Change Request
Design Field Change No.
Subject of Design Change
Section-1 Request for Design Change (by Requester)
-1 Date Design Change Requested
-2 Discipline
Requester's Name Approved by
Title Title
Signature Signature
Section-2 Detail of Design Change (by Requester)
-1 Description of Design Change
Document No.
Rev No.
Item Line No.
-2 Reason of Change (1) Company Request (9) Function or Performance issues
(2) P&ID/HAZOP/HAZID (10) Revision for Safety
(3) Process Design Change (11) Revision for Operability
(4) Vendor's Design Change (12) Revision for Maintenance
(5) Vendor's Info Incorporation (13) CAD Error
(6) Release of Hold (14) Start Up Comment
(7) Piping Design Incorporation (15) Others (Engineering Development)
(8) Instrumentation Design Incorporation
comment/others: ___________________________________________________
___________________________________________________
___________________________________________________
-3 Impact to Other Facilities Design impact to other discipline ( ) Comments:
Rework required at site ( )
Impact to vendor
Schedule Cost
impact to subcontractor
Schedule Cost
Section-3 Evaluation (by Requester and FEM)
Requester (sign) EM (sign) CPY (sign) Final Check
Yes No Yes No Yes No (by EM)
-1 Change Order Required Major Change
-2 Major Item ? (Site office Required) Minor Change
-3 COMPANY's comment, if any:
Section-4 Approval (by EM, SM, PM, COMPANY)
-1 Approval of Engineering Manager Approved as Requested
Date PM Approval Required SM Approval Required
Signature Not Approved Company Approval Required
Reason:
-2 Approval of Project Manager
(if required)
Date Approved as Requested
Signature Not Approved
Reason:
-3 Approval of Site Manager
(if required)
Date Approved as Requested
Signature Not Approved
Reason:
-4 Approval of COMPANY
(if required)
Approved by Approved as Requested Not Approved
Title
Signature Reason:
Date