T MU MD 00011 F1
Request for Concession to ASA Requirement
Issued Date: 22 September 2015
Date received: / Concession
Request for Concession to ASA RequirementGeneral details
Contract or Project name
Concession description - General
(Specify to what the concession applies to; for example: rolling stock, substation etc. with specific identification details such as geographical location, kilometrage, line, asset name, item number)
Details of concession
Relevant ASA standard
(Specify the document number, title and version ) / Section
(Specific section against which the concession is sought)
Specific requirement that cannot be met
(State the requirement against which concession is sought, as set out in the ASA standard)
Type of concession requested
(Select the type of concession sought)
TemporaryStart date:Expiry date:
Interim (valid for 10 working days only from the date of issue)
Justification why the requirement is not reasonably practicable to be met or how the proposed alternative solution provides a better outcome to TfNSW than a compliant solution.
Proposed alternative solution
(Specify the proposed alternative solution that will apply in the place of relevant ASA requirement)
Other options identified
(Specify other alternative solutions identified and why the proposed alternative is best suited and others excluded)
Whole-of-life cost implications to TfNSW if proposed alternative is accepted
(Provide cost comparisons of all viable options considered)
Risk assessment details
Risk assessment report - This report is mandatory and shall be a separate detailed report that includes the following:
- risk controls to mitigate risk to SFAIRP (so far as is reasonably practicable) (risk control owners shall be clearly identified)
- residual risks
Factors which bear on the risk, both positive and negative
Implications on non-safety related aspects such as reliability, maintenance requirements, durability, track access etc.if proposed alternative is accepted
Other supporting documents or artefacts
(List supporting evidence provided with this request to justify claims or technical assessments)
Requestor details(Refer to Section 5.7 of T MU MD 00011 ST for information on requestor)
Name of requestor
Organisation and position title
AEO authorisation number (as applicable)
Signature / Date:
Endorsement by responsible body(Refer to Section 5.8 and Section 5.8.1 of T MU MD 00011 ST for information on endorsement by responsible body)
Evidence demonstrates that all alternative options have been sufficiently investigated and addressed.
Stakeholder interests have been properly investigated and addressed.
The proposed deviation and risk controls do not give rise to new risks or outcomes that are unacceptable to TfNSW.
All information relevant to the request is available and attached including the list of stakeholders consulted by the Responsible Body - names of organisations and the name and position title of the representative of each of the organisations.
Organisation / Mobile
Email address / Telephone
Signature: / Date:
All requests shall be duly filled, signed by the requestor, endorsed by the responsible body and submitted in electronic format to ASA Standards at .
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