Date :


Initiator Name & Designation:



Department Name:



Description of Change:






Reason for Change:





 Document Name: ( To be Amended)

Revision No:

Doc No:

Initiator Name                     

Signature & Date

Department Head Name           

Signature & Date

To be Filled by Department Head

Impact of Change control:




Department Head Name:  



Signature & Date:

To be Filled by Quality Assurance Department

Feasibility of Change                Yes                   No

Status:                                        Approved         Not Approved

Date of Implementation of amended documentation:

Amended document distributed to


HOD Production                                    HOD Ware House      

HOD Quality Control                             HOD Human Resource 

HOD Quality Assurance                         HOD Engineering 

Final Approval and Authorization:

Quality Assurance Manager/MR

Signature & Date: