Low Value Change Request

Dated …………………………

To be completed by Authority Representative

Change no:

Brief description of the Change

Change in Law/

Budget for the Change

Date for completion/implementation

To be completed by Contractor Representative

Confirmation of Price/Time (if applicable)

Can be carried out within existing on site resources?

If not, cost of labour rates

lifecycle cost (if appropriate)

additional operating cost (if appropriate)

plant/equipment costs (if appropriate)

Total cost