Request To Modify Conduct Of Regulated Activity Due Covid-19 Impact

Instruction to fill the form
In the Description field
Briefly describe deviation from usual operation.
Explicitly state what is foreseen impact on current SAFETY, SECURITY or SAFEGUARDS measures.   
Explicitly state inventory items of concern - include FANR RAN numbers, and change in STATUS if any   
Explicitly state facilities or areas or locations of concern - include modifications to controlled areas and LOFs    
Explicitly state staff names with their roles of concern - who is rendering sources safe / using / operating sources , etc.
Any other information you find important  

In the Justification field
Briefly state reason for the modification of regulated activity,  

 

 

Is this request issued under the authority of the originators legal representative?  
Urgent  
If this Request is a result of Government entity communication, explicitly state the following: Please attached the communication along with this request to FANR
Attachment
(Maximum file size 2MB)
Full Government entity name:
Date of the communication:
Government entity reference number
for the communication
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