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
36C26026Q0148
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This document is an Engineering Deviation Request Template from the Department of Veterans Affairs. The template provides a structured format for submitting code/design deviation requests to the Office of Healthcare Engineering, allowing requestors to propose waivers, equivalencies, or abeyances for specific project requirements. The template requires detailed information including the source of the requirement, type of deviation requested, a comprehensive summary and justification, potential risks associated with the deviation, and supporting documentation. Requestors must sign the document and agree to adhere to monitoring/mitigation strategies and any additional conditions imposed by the Deviation Review Committee, with the potential for additional approval from Medical Center or Network Directors depending on the request's impact and associated 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
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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 .