Change Control Number: ____________________________
Requester to Complete
1. Requester Information
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Name of Requester
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Department
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Contact
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Urgency of change
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Date
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2. Change information
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Action
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Document to be changed (if known)
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Document number to be changed
(if known) i.e. SS-XXXX-00A
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Raw material code
or Finished Product
code and description
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Code:
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Description:
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Other related information
i.e. DR; Audit
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3. Details of Change
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Reason for Change
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Current value/text
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Proposed value/text
Technical Service
to Complete
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Type of Change
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Documents affected (including Technical
Document, SOPs, Artworks)
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Other Codes affected
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Update required in database
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Technical Service Manager
to Complete
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Technical Service Manager
Approval for
Change to go Ahead
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Yes
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Yes with additional approval
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Sign
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Date
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Other to Complete
(If required)
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Laboratory Manager
(or delegate)
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Name
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Sign
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Date
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Comment
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QA Manager
(or delegate)
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Name
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Sign
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Date
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Comment
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Regulatory Manager
(or delegate)
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Name
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Sign
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Date
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Comment
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Associated Supply
Manager
(or delegate)
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Name
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Sign
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Date
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Comment
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Technical Service
Coordinator
Name:
Change Completion
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Coordinator
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Name
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Sign
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Date
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Approval for change
completed
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Name
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Sign
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Date
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Comment
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