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Requesting Entity

Sent by the requester to the "mtier" or specialty in head quarters responsible for the concerned CR-GS


Prepared by: To be prepared by all entities concerned
Authorised by:

Reference Number: Requester number

Site / Project / System:

Indicate clearly which system is concerned and the stage (design, engineering, construction, field operation,

Description of Request:
Indicate in the documents (CR-GS) the paragraphs on which the derogation is requested.
Describe the local situation, constraints, expected problems, and alternate solutions, if any.
Explain the reasons for not conforming to the documents.

Benefits expected:
Evaluate the benefits expected by comparison between the situations with conformance to the document and with
derogation to the documents.
All types of benefits should be listed in short term/long term, quantifiable or not such as speed up of project, improved
system reliability or operability. In any case try to estimate a value in money or hydrocarbon production.
All evaluation data hypothesis should be clearly mentioned (unit and rental cost, time saved ...).

Additional risks (related to all kind of deviations from standard situation):

Evaluate the risks by comparison between the situations with conformance to the document and with the derogation to
the documents.
A risk is a combination of the probability of occurrence and the associated consequences of an abnormal event or
situation. If possible provide a QRA study.
Consider every deviation from the situation in conformity with the document which could badly impact persons, safety,
environment, materials, production, contracts, legal, social or other.
Estimate also indirect consequences like delays and costs to return to a standard situation, or due to any chain of events
or others.

Precautions to minimise additional risks:

Describe the means to minimise both the occurrence and consequences of the above listed additional risks

Other comments:
For instance, indicate the initiation of the demand, like a contractor suggestion, a PTR item or other and whether similar
derogation has already been recorded over last years.

Latest expected answer date:

Indicate the time constraints for the requester.

Sent by:






List of support documents:

This form is a framework which highlights the main information required to efficiently follow the
process of the derogation requests.
The explanations are printed in blue; they must be erased in the actual request form.
Please send the mail regarding this demand with a copy to the mail box: EP.DEROGATIONS@total.com

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