Requester Full Name
Department or Organization
Contact Email Address
Contact Phone Number
Project Name or Title
Project ID or Tracking Number
Type of Alteration
New Equipment Installation
Existing Equipment Modification
Cable Infrastructure Changes
Power Distribution Changes
Cooling System Alteration
Network Architecture Change
Physical Relocation of Equipment
Decommissioning/Removal
Other:
Is this an emergency or urgent alteration request?
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)
Server Hardware (Rack-mounted)
Networking Equipment (Switches, Routers, Firewalls)
Storage Systems (SAN, NAS, DAS)
Power Distribution Units (PDUs)
Uninterruptible Power Supplies (UPS)
Cooling Units (CRAC, In-row Cooling)
Cable Management Systems
Environmental Monitoring Systems
Physical Security Systems (Access Control, CCTV)
Fire Suppression Systems
Backup Power Generators
Other:
Will this alteration affect infrastructure shared with other tenants or departments?
Does this alteration require access to common areas or building core systems?
Overall Risk Level Assessment
Low Risk - Minimal disruption, well-documented procedure
Medium Risk - Moderate disruption, some complexity
High Risk - Significant disruption, complex procedure, requires careful planning
Critical Risk - Severe potential impact, high complexity, extensive mitigation required
Potential Impact on Service Availability (1 = No Impact, 5 = Complete Outage)
Identified Potential Hazards or Risks (select all that apply)
Electrical Hazard (shock, arc flash)
Thermal Management Failure (overheating)
Fire Risk
Physical Injury (lifting, sharp edges)
Network or Connectivity Disruption
Data Loss or Corruption
Equipment Damage
Environmental Release (coolant, battery acid)
Unauthorized Access or Security Breach
Cascading Failure to Other Systems
None of the above
Detailed Risk Mitigation and Control Measures
Is a documented rollback or backout plan available if issues occur?
Has a test plan been developed to verify successful implementation?
Total Estimated Power Load Increase (in kW)
Additional Cooling Capacity Required (in kW or BTU/hr)
Will this alteration require network or connectivity changes?
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
Equipment Type | Manufacturer and Model | Quantity | Power Draw per Unit (Watts) | Estimated Cost per Unit | Total Cost | |
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Will this alteration impact the fire suppression or detection system?
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?
Required Permits or Certifications (select all that apply)
Electrical Work Permit
Hot Work Permit (welding, cutting)
Confined Space Entry Permit
Working at Heights Permit
After-Hours Work Authorization
Vendor or Contractor Background Check
None Required
Will external contractors or vendors be performing the work?
Is valid liability insurance coverage confirmed for all parties involved?
Proposed Start Date and Time
Estimated Duration (in hours)
Impact on Business Operations
No impact - after hours, no users affected
Minimal impact - after hours, minor background services affected
Moderate impact - weekend/maintenance window, some services offline
Significant impact - business hours, major service degradation expected
Severe impact - business hours, complete service outage required
Systems or Services Potentially Affected (select all that apply)
Email and Collaboration Systems
File Storage and Backup Systems
Customer-Facing Applications
Internal Business Applications
Database Services
Network Connectivity (LAN/WAN)
Internet Access
Physical Access Control Systems
Environmental Monitoring/DCIM
No significant systems affected
Upload Communication and Stakeholder Notification Plan
Have all affected stakeholders been formally notified?
Has internal management approval been obtained?
Has landlord or property management approval been obtained (if required)?
Has technical or engineering review been completed?
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?
Post-Implementation Monitoring Period (in days)
Will as-built documentation be updated after completion?
Should a lessons learned review be conducted after project completion?
Note: Final approval to proceed will be contingent upon satisfactory review of all sections, required approvals, and mitigation measures. The alteration must not commence until formal written authorization is received.