TW Customer Connection Variation Request

• Panel Member

• Date

  Date

• Prepared by

  Select

• Statement of Work Number: NC 2023/

• Connection Address

• Work Order Number

• Please provide an explanation (with supporting documentation including photos) as to why the variation is necessary

• Details of Variation Requested

• Who within TasWater has the Variation been discussed with?

• Date

  Date

• Has the Customer Site Contact been made aware of the Variation?

  Yes

  No

  N/A

• Name

• Date

  Date

• Contact Made:

  In Person

  By Phone

  By Email

• Reason

  Yes

  No

  N/A

• Please note: If the customer has not been contacted for a variation chargeable to them the variation will be declined by TasWater

Impact on Cost

• Variation Estimate / Final Cost (if possible)

• Is this an estimate or a final cost

  Estimate

  Final Cost

Impact on Timing of Delivery of Services

• Will the Delivery of Services be impacted

  Yes

  No

  N/A

• Original Completion Date:

  Date

• Anticipated Completion Date:

  Date

• Additional Information (if any)

• Signature

  Sign

• Name of Authorised Signatory

  Select

• Date

  Date

• Variation Accepted by Taswater

  Yes

  No

  N/A

• 

• Variation Work Order Number:

• Signature of Authorised Signatory

  Sign

• Name of Authorised Signatory

• Is this chargeable to the customer

  Yes

  No

  N/A

• 

• 

• PM = Customer Connection Project Manager, SCO = Senior Compliance Office, DST = Development Support Team