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  • HSE Exception Request Form Rev.1

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    Dhimaz Yudi
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    This form is used to request exceptions to health, safety, and environment (HSE) standards and procedures at a facility. It requires the initiator to provide the title and duration of the proposed work, describe how it exempts from HSE rules, and get approval signatures from the field manager, project manager, contractor HSE representatives, and HSE procedure analyst. Any risks are also assessed, with compensating measures and responsible parties identified to mitigate hazards.

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    HSE Exception Request Form Rev.1[1]

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    This form is used to request exceptions to health, safety, and environment (HSE) standards and procedures at a facility. It requires the initiator to provide the title and duration of the proposed work, describe how it exempts from HSE rules, and get approval signatures from the field manager, project manager, contractor HSE representatives, and HSE procedure analyst. Any risks are also assessed, with compensating measures and responsible parties identified to mitigate hazards.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    97 views1 page

    HSE Exception Request Form Rev.1

    Uploaded by

    Dhimaz Yudi
    This form is used to request exceptions to health, safety, and environment (HSE) standards and procedures at a facility. It requires the initiator to provide the title and duration of the proposed work, describe how it exempts from HSE rules, and get approval signatures from the field manager, project manager, contractor HSE representatives, and HSE procedure analyst. Any risks are also assessed, with compensating measures and responsible parties identified to mitigate hazards.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    COPI HSE Exception Request Form

    This form shall be completed by Initiator and sent to all parties listed below for approval and registration purposes Section 1 - Initiation Title: Date Exception Starts: Facility: Description of how proposed work exempts from HSE Standard and Procedure: Initiator Name: Date Exception Expires: Site:

    HSE Standard or Procedure Exception reference: Acknowledged by Field Manager/Project Manager* *Including Logistic Manager for Matak Base Section 2 Risk Assessment Risk Assessment Group : No. Name Signature Date Title Name and Signature:

    Contractor HSE Reps (if applicable) Table of Summary of Risk Assessment Compensating Measure: No. Hazard/Risk Identified Mitigating Measure Responsible Person Target Date

    If required, separate sheet may be added. Section 3 Approval No. Name Title Signature and Date HSE Exception No:

    Note: Shall be obtained from HSE Procedure Analyst Disapproved by: No. Name Title Signature and Date Reason for Disapproval

    Does this Exception prompt a permanent revision in the HSE Standard and Procedure? Yes/No (select one) Cc: HSE Procedure Analyst

    COPI-HS-FR-00102 Rev. 0

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