Diamond NBN Field Variation Request

• Enter the text "NBN Field Variation Request"

• Field Variation Number (Do not enter data here - note the auto number and input to FVR number on the next page)

• This Field Variation Request (FVR) is to be completed for ALL changes to the original scope of the works. Ensure that the FVR is signed off by a Diamond and Client representative at the site of the FVR.

• Email this FVR to the appropriate Diamond and Client representatives.

Field Variation Request

• Date

  Date

• FSAM

  Select 6VIC01 6VIC02 6VIC03

  • 6VIC01
  • 6VIC02
  • 6VIC03

• FDA

  Select Distribution 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

  • Distribution
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
• Location
  Address

• FVR Number (field variation request) from the previous page

• Project Manager

  Ryan Hickey

  Ian Hampson

  Steve Capaldi

  Ross Baker

Variation Items

• What is the change

  Bore to Trench

  Haul to Trench

  Trench to Bore

  Other

• If 'Other' please name the change

• MANDATORY REQUIREMENTS TO SUBMIT THIS FORM:
  -Pre Construction Photograph
  
  REMEMBER TO ALSO PROVIDE
  -Post Construction Photograph
  

• Pre Construction Photo

  Media

• Post Construction Photo

  Media

• Asbestos Duct

  No

  Yes

  N/A

• Reason for Change

Certification

• Diamond Certification

• I certify that the information provided is an accurate reflection of the works undertaken or to be undertaken.

  Sign

• Client Certification

• I certify that the information provided is an accurate reflection of the works undertaken or to be undertaken.

  Sign