Permanent Deviation Request Pro Forma
Unique Dispensation Reference:
Dispensation
requested by:
Position and company:
Installation:
Export Route (e.g. pipeline system):
Measurement System:
Component:
Description of measurement issue:
Estimated additional uncertainty arising:
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On behalf of
(Operating
company):
Date of
Request
(DD/MM/YY):
Estimated increased financial exposure (using ‘Integrated Risked Exposure’
approach – ref. para. 4.2 of DECC Guidelines):
Estimated cost of remedial action required to correct deviation:
List of documents references:
FOLLOWING SECTION TO BE COMPLETED BY DECC
Deviation
Agreed? (Y/N):
Comments:
Date
(DD/MM/YY):
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