SCM‑NUMS · Governance Templates
Printable templates that support the SCM‑NUMS master governance binder — Change Request Form, UAT Feedback Form, Incident Report Form, Training Attendance Register and Document Sign‑Off Form. Each template starts on a new page for clean printing.
KwaZulu‑Natal Department of Health
ICT Governance & System Assurance
Document: KZN/ICT/SCM-NUMS/2026/001
Template: TPL‑CHG‑001
Version: 1 · 23 September 2026
T1Change Request Form
Use this form for every new change request after CH‑005. Requests are always raised by Mr Mtshali and Mr Mkhize. The next change ID begins at CH‑006.
Change ID
CH-006 (auto‑generated; increment for each new request)
Request Date
[Date]
Requested By
Mr Mtshali & Mr Mkhize
Change Description
[Detailed description of the change]
Business Justification
[Reason for change]
Impact Assessment
[Low / Medium / High]
Category
[Functional / Security / UI / Data / Integration / Infrastructure]
Testing Required
[Yes / No]
Approval Status
[Pending / Approved / Rejected]
Approved By
[Name, Role] · Approval Date: [Date]
Deployment Date
[Date]
Rollback Plan
[Documented rollback steps]
Notes
[Any additional context]
Approval
Requested By — Mr Mtshali
Signature
Date: _______________
Requested By — Mr Mkhize
Signature
Date: _______________
Technical Lead · Project Manager — Mr Themba Sikosana
Signature
Date: _______________
Change Control Board Chair — Mr Mtshali
Signature
Date: _______________
Reference: The completed change request forms for CH‑001 to CH‑005 are in Section 13.3 of index.php.
KwaZulu‑Natal Department of Health
ICT Governance & System Assurance
Document: KZN/ICT/SCM-NUMS/2026/001
Template: TPL‑UAT‑001
Version: 1 · 23 September 2026
T2UAT Feedback Form
Completed by each UAT participant after every scenario group. Used to measure user satisfaction, ease of use, system performance, feature completeness and training effectiveness.
Participant Details
Participant Name
Role
Facility / District
Date
UAT Scenario(s) Assessed
User Satisfaction
To be measured via feedback forms.
Overall satisfaction with the SCM‑NUMS experience
1Very Poor
2Poor
3Fair
4Good
5Excellent
Ease of Use
To be rated by users.
Navigation and screen clarity
1Very Difficult
2Difficult
3Neutral
4Easy
5Very Easy
Completing a uniform requisition end‑to‑end
1Very Difficult
2Difficult
3Neutral
4Easy
5Very Easy
System Performance
To be rated by users.
Page load and response time
1Very Slow
2Slow
3Acceptable
4Fast
5Very Fast
Features
To be reviewed for completeness.
| Feature | Complete? | Comments |
|---|---|---|
| Registration | ☐ Yes ☐ No | |
| Order Placement | ☐ Yes ☐ No | |
| Order Editing | ☐ Yes ☐ No | |
| Supervisor Approval | ☐ Yes ☐ No | |
| Account Activation | ☐ Yes ☐ No | |
| Catalogue Management | ☐ Yes ☐ No | |
| Reporting | ☐ Yes ☐ No | |
| Audit Log Review | ☐ Yes ☐ No |
Training
To be assessed for effectiveness.
Effectiveness of the training received before UAT
1Not Effective
2Weak
3Adequate
4Effective
5Highly Effective
Recommendations
To be documented for future releases.
Recommendation / Improvement Suggestion
Sign‑Off
UAT Participant
Signature
Date: _______________
UAT Coordinator · Project Manager / Technical Lead — Mr Themba Sikosana
Signature
Date: _______________
KwaZulu‑Natal Department of Health
ICT Governance & System Assurance
Document: KZN/ICT/SCM-NUMS/2026/001
Template: TPL‑INC‑001
Version: 1 · 23 September 2026
T3Incident Report Form
Completed for every SCM‑NUMS incident. Refer to Section 15 in index.php for priority definitions and escalation path.
Incident ID
[Auto‑generated]
Date
[Date]
Reported By
[Name, Role]
Priority
[P1 / P2 / P3 / P4]
Incident Description
Impact (users affected)
Systems / Modules Affected
Resolution
Status
[Open / In Progress / Resolved / Closed]
Closure Date
Escalation
| Level | Owner | Contacted | Date / Time |
|---|---|---|---|
| Level 1 | Helpdesk Support | ☐ Yes ☐ No | |
| Level 2 | Mr Themba Sikosana & SCM Team | ☐ Yes ☐ No | |
| Level 3 | ICT Manager | ☐ Yes ☐ No | |
| Level 4 | CIO | ☐ Yes ☐ No | |
| Level 5 | Head of Department | ☐ Yes ☐ No |
Sign‑Off
Reported By
Signature
Date: _______________
Technical Lead · Project Manager — Mr Themba Sikosana
Signature
Date: _______________
KwaZulu‑Natal Department of Health
ICT Governance & System Assurance
Document: KZN/ICT/SCM-NUMS/2026/001
Template: TPL‑TRN‑001
Version: 1 · 23 September 2026
T4Training Attendance Register
Completed by the trainer at each SCM‑NUMS training session. Kept as audit evidence under Section 17 of index.php.
Session Title
Session Date
Venue / Location
Trainer Name
Target Audience
[Nurses / Supervisors / Stores / Head Office / Auditors]
Number of Attendees
Attendees
| # | Attendee Name | Role | Facility | Signature |
|---|---|---|---|---|
| 1 | ||||
| 2 | ||||
| 3 | ||||
| 4 | ||||
| 5 | ||||
| 6 | ||||
| 7 | ||||
| 8 | ||||
| 9 | ||||
| 10 |
Sign‑Off
Trainer
Signature
Date: _______________
Training Coordinator · Project Manager / Technical Lead — Mr Themba Sikosana
Signature
Date: _______________
KwaZulu‑Natal Department of Health
ICT Governance & System Assurance
Document: KZN/ICT/SCM-NUMS/2026/001
Template: TPL‑SGN‑001
Version: 1 · 23 September 2026
T5Document Sign‑Off Form
Used to formally approve a governance document, change request, UAT completion, go‑live readiness, or post‑implementation review.
Sign‑Off Type
[Document / Change / UAT / Go‑Live / PIR]
Date of Sign‑Off
Subject Being Signed Off
Conditions / Remarks
Signatures
Project Manager · Technical Lead — Mr Themba Sikosana
Signature
Date: _______________
Business Owner — Director: Supply Chain Management
Signature
Date: _______________
Change Control Board Chair — Mr Mtshali
Signature
Date: _______________
Internal Audit — Chief Audit Executive
Signature
Date: _______________
Once signed, return the completed form to the SCM‑NUMS governance repository and reference it in the next ICT Governance Committee pack.