Exception Request Online Form

Complete this form to request an exception from an information security policy, standard, or procedure. For more information, see the Exception Procedure.

Date*
MM slash DD slash YYYY
Requester's Name*
First Last
Requester's Email Address*
Requester's Phone Number*
Division or Department*
Relevant Information Security Policy, Standard, or Procedure
Description of the Non-Compliance Scenario*
(i.e., description of the situation that is to exist if an exception is granted)
Business Justification for the Non-Compliance Scenario*
Proposed Assessment of Risks or Threats Associated with Non-Compliance*
Proposed Plan for Managing Risk Associated with Non-Compliance*
(e.g., alternate risk mitigating security controls in place or that could be put in place)
Proposed Plan and Dates for Resolving the Non-Compliance Scenario*
Impacted Devices if Applicable (Manufacturers, Model, Operation System, Other Information)
Additional Helpful Comments and Information if Pertinent
Estimated Duration for the Exception
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Exception Request Approval
Exception requesters must ensure the appropriate supervisor, manager, or director has seen the request, agrees, and approves with their name and contact information.
Appropriate Business Manager Approver's Name*
First Last
Approver's Email*

Exception Request Online Form

Estimated Duration for the Exception

Exception Request Approval