SOW Attachment 06 - Engineering Deviation Request Template.docx

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C1DA--AE-NRM-687-26-100 Modernize Physical/Electronic Security Systems
Solicitation number
36C26026Q0146
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This document is an Engineering Deviation Request Template from the Department of Veterans Affairs, designed to formally document requests for code or design deviations in engineering projects. The template requires detailed information including the type of deviation (waiver, equivalency, or abeyance), source of requirement, project details, and justification for the requested deviation. Requestors must identify potential risks associated with the deviation, list supporting documentation, and agree to monitoring and mitigation strategies if the deviation is approved. The template includes signature lines for the requester and potentially the Medical Center or Network Director, depending on the deviation's impact and risks.

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Department ofMemorandum

Veterans Affairs

Date:
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From:
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Subj:
Code/Design Deviation Request

Project Number / Project Name

To:
Office of Healthcare Engineering (19HEFE)
Category of Request
Choose an item.
Source of Requirement, e.g. Directive, Design Guide, or Specifications; including section
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Summary of Requirement

Type of Deviation Requested: ☒ Waiver ☐ Equivalency ☐ Abeyance

Summary of and Justification for Request (Include project details, location of request, other implications. Identify risks associated with this deviation including if the deviation is not approved AND if the deviation is fully implemented.)

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List of Attachments and Supporting Documents (e.g., specifications, drawings, etc.)

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By signing this memorandum, the requestor(s) agree to adhere to all monitoring/mitigation strategies identified by the facility as well as additional conditions imposed by OHE if this or a modified deviation is approved. The requestor(s) understand that the Deviation Review Committee may request Medical Center or Network Director signature approval based on the impacts and risks associated with this request.
Signed (Request)
Signed (if requested)

Name Title (Chief Engineer)

Date
Name

Title Date https://dvagov.sharepoint.com/sites/VHA10NA5E/waiver/Pages/Waiver%20Requests.aspx

File details come from the government source that posted it. Updated .