Change id number: Process Change Worksheet


Must Implement Date (DD-MMM-YY): None



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Must Implement Date (DD-MMM-YY): None


(The date when the associated CAPA task is due, if applicable, or the date the change MUST be implemented by in order to prevent supply chain disruptions or shortages.)

(If neither “Must Implement Dates” apply, then leave “None” above.)



Change Detail Information




Change Type: (Check all that apply) As per section 2



General Manufacturing Sterilization Labeling Design *Material *Different Supplier Radio Regulatory IT System Other      

NOTE: For manufacturing materials and supplier changes refer to MPR-PPC-PP-009057 for additional requirements.




Background/Context: (Provide an expert overview in non-expert format/terms of the situation. Regulating Agencies are not familiar with our processes.) Suggested – Provide any information that could support understanding of the change and its context in non-expert terms



Instructions Note: Throughout this document all blue italics text indicates instruction and example content. It is intended to be deleted and/or replaced with authored content. Information in black text is required and must be included.
Examples to include (can be written as paragraph or list):

  • Describe component/process/item

  • Describe function of component/process/item, in final state at affected assembly level

  • Where in the value stream or process (supply chain or operation) the change is occurring

  • Relationship of supplier to other locations at Medtronic – flow diagrams, etc (if applicable)

  • Part/doc/software release number(s) being updated

  • When applicable, attach (DO NOT embed documents) supporting documents (redline, table, chart, graphic, etc).

  • Describe if change is part of a large or multiple phase project plan.




Reason for Change Checklist (Check all that apply)

Supporting Documentation List


Requires update to Site Risk Documentation (ex. FMEA):      

Implement Change Control # : ECO # or other traceable record      

Implement Deviation (or similar) #      

Yield/process improvement

Material availability

Cost savings

Correct engineering error (clarifying technical content)

Correct typing/document error – clerical error

Response to CAPA#      

Response to External Audit Finding      

Response to known/potential performance concern, risk,

or Field Issue      



Addition of new products or product model numbers

Medtronic initiated change at supplier

Other – explain:      


Site Risk Documentation (ex. FMEA): Supporting Document Number / ID:      

Characterization: Supporting Document Number / ID:      

Verification: Supporting Document Number / ID:      

Validation: Supporting Document Number / ID:      

Qualification: Supporting Document Number / ID:      

Equipment Installation: Supporting Document Number / ID:      

Other Testing or Rationale not listed above:      

Supporting Document Number / ID:      

Software Change Control Form / ID: ______________













Provide rationale for no testing:




______________



Outline the current template and future state (From/To) by filling out the following template. If needed, include additional detail in attached (NOT embedded) supporting documents/change table (for example, multiple sub-changes needed for one software release update).

From: supplier/BU is using component/spec/item for process to do x.

To: supplier/BU is using test for test to do some stuff
Notes:

  • If there are multiple changes, list and number each change separately as a From/To (1, 2, 3, etc).

  • Maintain the same numbering system throughout the change request.

  • Explain acronyms, vendor/supplier names, technical terms, materials, components, etc.

  • Describe if this change is related to future changes or if this change will be done in phases. Ensure each phase is described in detail.




Why change is being made.


Provide high level testing summary, as needed:

Enter the high-level summary of testing or enter “See rationale for no testing below”.



Provide rationale for no testing: Enter the rationale for no testing or enter “See high-level summary above”.



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