Short Service Employee (SSE) Exception Form

Short Service Employee (SSE) Exception Form

This form is to be filled out by the Project Manager and approved by the Roux Operations Manager and Project Principal whenever greater than 50% of Roux’s field workforce at any job site are SSEs (e.g., the only Roux field worker at the site is an SSE).
Project Name*
Site Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
SSE Name*

First NameLast Name
SSE Email*
name@rouxinc.com
Submitter Name*
The submitter must be a project, senior, principal, or VP-level personnel
Submitter Email
example@example.com
Office Location*
OM Email
example@example.com
OHSM Email
example@example.com
Project Principal*
Principal Email
example@example.com
SSE Variance Justification*
What are the current circumstances and justification for the SSE variance?
Alternatives to Variance*
If the variance is denied, what are the alternatives to completing the scope of work? Briefly detail the cost and operational impact of the alternatives.
Please list the steps to be taken to mitigate the SSE risk to an acceptable level*
Variance Start Date*

MonthDayYear
Date
Variance Expiration Date*

MonthDayYear
Date
CHSD Email
example@example.com
If you are unable to submit, please make sure all required fields have been filled.
Should be Empty: