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Contractor Variance Form - Contractor Safety - Mosaic

Contractor Variance Form - Contractor Safety - Mosaic 2026

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The Contractor Variance Form outlines the process for obtaining a variance for contractors not on the Mosaic Approved Contractor List or those with unacceptable ratings. It details the approval requirements from various management levels, the types of variances, and necessary evaluations regarding safety, training, and insurance before allowing non-qualified contractors to work on site. The form must be completed and signed by relevant personnel, with specific procedures for documentation and communication.

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Click ‘Get Form’ to open it in the editor.
Begin by selecting the type of variance you are applying for: Business Unit, Site, or Project Variance. This is crucial for categorizing your request.
Fill in the 'Person Requesting Variance' field with your name and contact information to ensure proper communication.
Enter the Contractor Company Name and Subcontractor Company Name as applicable. Accurate details help streamline the approval process.
Indicate the reason for the variance by checking one of the options provided: Not on ACL, Emergency work, or ISN rating ‘C’ or ‘F’. This helps clarify your request's urgency.
Describe the type of work being performed in detail to provide context for your variance request.
Specify the date when the contractor is needed on site and set a variance expiration date (maximum of one year).
Answer all evaluation questions thoughtfully, ensuring that safety protocols and training requirements are addressed thoroughly.
Gather necessary signatures from relevant parties including Project Manager, Superintendent, Safety, Buyer, and General Manager before submission.

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