Request for Review of Nonconformance to ASA Requirement

T MU MD 00011 F2
Request for Review of Nonconformance to ASA Requirement
Version 1.0
Issued Date: 22 September 2015

Asset Standards Authority (internal use only)
Date received: / Nonconformancereview
request no:

Request for Review of Nonconformance to ASA Requirement

General details
Contract or Project name
Nonconformancedescription – General
(Describe the nonconformance including to which asset it applies, its location and the extent of the deviation from the requirement)
Details of nonconformance
Relevant ASAstandard
(Specify the document number, title and version ) / Section
(Specific section against which review ofnonconformance is sought)
Specific requirement that has not been met
(State the requirement that was not complied with, as set out in the ASA standard)
Incident that led to the situation
(Specify the reason that led to nonconformance)
Justification why conformance to requirement is not reasonably practicable to achieve
(Specify the reasons why it is not reasonably practicable to achieve compliance now)
Method adopted to mitigate the nonconformance risk
(Describe how the situation is managed now and into the future)
Risk assessment details
Risk assessment report - This shall be a separate detailed report and shall include the following:

hazards
risk controls to mitigate risk to SFAIRP (so far as is reasonably practicable) (Risk control owners shall be clearly identified)
residual risks

Implications of the nonconformance on non-safety related aspects such as reliability, maintenance requirements, durability, track access etc
Whole of life cost implications to TfNSW due to nonconformance including ongoing maintenance of additional risk controls
Lessons learnt and preventive action to avoid recurrence
Supporting documents
(list supporting evidence provided to justify claims made in this request)
The inclusion of the risk assessment report and the detailed plan for future management of the nonconforming work ismandatory.
AEO endorsement
Technical integrity of the asset has not been compromised by the nonconforming work.
Overall safety of the network has not been compromised by the nonconforming work.
Future management of the nonconformance is planned.
AEODetails
Name of AEO representative
Position title and organisation name
AEO authorisation number
Email address
Signature: / Date:
Requestor (Responsible Body) endorsement
All relevant stakeholders have been consulted and have endorsed the management plan
Representative name
Position title
Organisation / Mobile
Email address / Telephone
Signature: / Date:

All requests should be duly filled, signed by the requestor, endorsed by the responsible body and submitted in electronic format to ASA Standards at .