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Shell - HSE0172 PR01 Rev0.0
Shell - HSE0172 PR01 Rev0.0
Company: Date:
This form must be submitted to the Shell UWA/Designee for Approval of Early Removal or Variance to
the SSE Policy. Form below may be used for a contract employee or a group of contract employees.
DW-GOM Standard Page 20 of 28
December 2018 Contractor HSSE Management Rev 0.0
The controlled version of this “Business Control Document” resides online. Printed copies are UNCONTROLLED.
Select Early Removal or Variance in the drop down option of the Action column for each name
Name Company Action Justification UWA/Designee
Approval
Select Select Approve or
Action Reject
Select Select Approve or
Action Reject
Select Select Approve or
Action Reject
Select Select Approve or
Action Reject
Select Select Approve or
Action Reject
Select Select Approve or
Action Reject
Select Select Approve or
Action Reject
Select Select Approve or
Action Reject
Select Select Approve or
Action Reject
Select Select Approve or
Action Reject
Select Select Approve or
Action Reject
Select Select Approve or
Action Reject
Select Select Approve or
Action Reject
Select Select Approve or
Action Reject
Select Select Approve or
Action Reject
Select Select Approve or
Action Reject