L4-CHE-FOR-075 / Version: 1 / Effective from: 1stAugust 2017
MTMDispensation Number: / (To be assigned by the OCE) / Consultant Reference No: / (To be completed by Designer)
Project Name: / (To be completed by Project Manager) / Work Order
No: / (To be completed by Project Manager)
PART A–Drawing Dispensation Request
(to be completed by the Designer & submitted to the Office of the Chief Engineer for Approval, via email address: )
Dispensation Type / A1 / B1 / B3
A2 / B2 / B4
Disciplines Impacted / Architectural / Building Services / Track & Civil
Civil Structural / Electrical Network / Signals
Telecommunications / Structural / Others
Requestor Details / Name / Position / Email / Phone Contact / Signature / Date
Scope of Work / Project / Design Undertaken:
PART B- List of Drawings SeekingDispensation
Item No. / DMS Drawing No. / Rev / New or Existing / Controlled or Uncontrolled / Supersede Drawing No / Drawing Title / Attachments
(Include any Agreement if drawing uncontrolled)
1.
2.
3.
4.
Expand table if required
PART C–Drawing DispensationDetailsDispensation Title / Description
Background:(Provide an overview of the existing drawing(s), their current condition (compliant, partial compliant or non-compliant) and what your project / design is expecting to change on the drawings
Justification (for Each Drawing Required):(Include reasonswhy the dispensation should be granted(use additional sheet if required) including details of alternative solutions considered and the reason they were not adopted / could not be made compliant.)
Drawing Dispensation Assurance Argument:(Detail the assessment of risks associated with the drawing(s) being Non-Compliant and your argument providing assurance demonstrating the risks associated with the drawing(s) have been managed SFAIRP on maintenance of assets, rail operations and future designers. Provide clarification on site correlations undertaken prior to work commencement, and assurance that the overall system integrity is not impacted and system functionality is as intended.)
Include additional sheets if required
PART D–Dispensation Request Registration(To be completed by OCE)Registered By: / Registration Date:
To be Reviewed By:
Drawings within control of the applicant (i.e. Booked Out by the Applicant)
Drawings not within control of the applicant however Agreement in place to take control eventually (i.e. Currently Booked Out by another Consultant but Agreement supplied)
Any Drawings in Dispensation Request Not in Control by the Applicant Designer nor covered by Agreement
PART E – Drawing Dispensation Approval (To be completed by OCE)
The following conditions are placed on the approval of this Drawing Dispensation. While a dispensation request may be applied under one Type, Engineering may choose to grant dispensation under another Type or choose to Reject the Dispensation Request entirely.
Approval (including Condition(s) of Approval if Applicable) / Type
Name: / Signature: / Date:
Comments and Rationale:
Approving Manager: Chief Engineer / Approval Date: 01/08/2017 / Next Review Date: 01/08/2019
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