Facilities Engineering Work Request
Download a blank fillable Facilities Engineering Work Request in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Facilities Engineering Work Request with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2FACILITIES ENGINEERING WORK REQUEST
For use of this form, see DA Pam 420-6; the proponent agency is OACSIM.
DOCUMENT
CUSTOMER
DATE
PART A
SHORT JOB DESCRIPTION
SERIAL
(See requestor
ID
NUMBER
DA
MON
YR
instructions)
INSTALLATION
BUILDING/FACILITY NUMBERS
ABBREVIATION
OF FACILITIES
1
2
3
4
5
6
7
8
9
10
1
2
3
REMARKS
INSTALLATION NAME
CUSTOMER NAME
POC NAME
POC PHONE NUMBER
WORK DESCRIPTION (Description and justification of work request)
AUTHORIZED REQUESTOR (Type or print)
AUTHORIZED REQUESTOR SIGNATURE
APPROVAL ACTION CODE:
SPECIAL INTEREST CODE:
DATE
PART B
WORK REQUEST PRIORITY:
DA
MON
YR
ESTIMATED WORK START DATE:
(Approving Official Only)
ESTIMATED WORK COMPLETION
PROGRAM INDICATOR CODE:
DATE:
ENVIRONMENTAL IMPACT
WORK TO BE PERFORMED
WORKCLASS
APPROVAL AMOUNTS
SOURCE OF FUNDS
FUNDED
UNFUNDED
YES
NO
IN-HOUSE
DIRECT
ENVIRONMENTAL
AUTOMATIC REIMBURSEMENT
CONSIDERATION
SELF-HELP
$
$
FUNDED REIMBURSEMENT
EIS / EIA
$
$
CONTRACT
INITIATED
ACCOUNT PROCESSING CODE
$
$
EIS / EIA
TOTAL
TROOP
COMPLETED
$
$
DESIGN APPROVAL (Please type or print name)
APPROVAL AUTHORITY (Please type or print name)
DATE
APPROVAL ACTION
DATE
DA
MON
YR
DA
MON
YR
DESIGN APPROVAL SIGNATURE
APPROVAL AUTHORITY SIGNATURE
APPROVED
DISAPPROVED
APD LC v1.03ES
DA FORM 4283, AUG 1978, IS OBSOLETE.
DA FORM 4283, SEP 2003
Page 1 of 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business