Tenant IT Server Room & Critical Infrastructure Alteration Form

Requester Full Name

Department or Organization

Contact Email Address

Contact Phone Number

Project Name or Title

Project ID or Tracking Number

Type of Alteration

Please describe the decommissioning scope and data sanitization requirements:

Is this an emergency or urgent alteration request?

Explain the emergency nature and why standard approval timelines cannot be met:

Brief Project Description and Business Justification

Facility or Building Name

Specific Room, Area, or Rack Designation

Current Infrastructure State Description

Detailed Scope of Proposed Alterations

Categories of Infrastructure Components Involved (select all that apply)

Will this alteration affect infrastructure shared with other tenants or departments?

Identify affected parties and describe the shared infrastructure impact:

Does this alteration require access to common areas or building core systems?

Specify required access locations and coordination requirements:

Overall Risk Level Assessment

Potential Impact on Service Availability (1 = No Impact, 5 = Complete Outage)

Identified Potential Hazards or Risks (select all that apply)

Describe electrical safety measures and qualified personnel requirements:

Describe cooling redundancy and temperature monitoring during work:

Describe fire watch procedures and suppression system isolation plan:

Describe how cascading failure risk will be mitigated:

Detailed Risk Mitigation and Control Measures

Is a documented rollback or backout plan available if issues occur?

Upload rollback plan document

Explain why no rollback plan is feasible and describe alternative risk controls:

Has a test plan been developed to verify successful implementation?

Summarize the testing and verification procedures:

Total Estimated Power Load Increase (in kW)

Additional Cooling Capacity Required (in kW or BTU/hr)

Will this alteration require network or connectivity changes?

Describe network changes including VLANs, IP addressing, port requirements, and firewall rules:

Additional Rack Space Required (in Rack Units)

Weight of New Equipment (in kg or lbs)

Upload Detailed Cable Management and Routing Plan

Upload Network Diagram or Architecture Diagram

Equipment Specifications and Cost Estimate

Will this alteration impact the fire suppression or detection system?

Describe impact and coordination plan with fire safety systems:

I confirm that all proposed equipment meets relevant environmental and safety standards (e.g., energy efficiency, RoHS compliance)

Has the facility safety officer or equivalent been notified?

Safety Officer Name and Contact:

Explain why safety officer notification is pending and planned notification date:

Required Permits or Certifications (select all that apply)

Electrical permit number or application status:

Describe fire watch and hot work safety measures:

Will external contractors or vendors be performing the work?

List contractor companies, scope of work for each, and their insurance verification status:

Is valid liability insurance coverage confirmed for all parties involved?

Proposed Start Date and Time

Estimated Duration (in hours)

Impact on Business Operations

Describe business justification for business hours work and stakeholder approval:

Describe business justification for business hours outage and stakeholder approval:

Systems or Services Potentially Affected (select all that apply)

Upload Communication and Stakeholder Notification Plan

Have all affected stakeholders been formally notified?

Describe notification plan and timeline for remaining stakeholders:

Has internal management approval been obtained?

Approving Manager Name and Title:

Explain approval status and expected date:

Has landlord or property management approval been obtained (if required)?

Property Manager Contact and Approval Reference:

Explain why property management approval is not required or pending:

Has technical or engineering review been completed?

Technical Reviewer Name and Department:

Describe planned technical review process and timeline:

Upload Supporting Documentation (approvals, diagrams, vendor quotes, etc.)

I certify that all information provided is accurate and complete to the best of my knowledge

Requester Signature

Will post-implementation testing be performed?

Describe testing procedures and success criteria:

Explain why post-implementation testing is not applicable:

Post-Implementation Monitoring Period (in days)

Will as-built documentation be updated after completion?

Responsible party for documentation update:

Should a lessons learned review be conducted after project completion?

Proposed participants and review scope: