Plant Operations Work Request Form
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1WORK ORDER NO: ___________________
Plant Operations
WORK REQUEST FORM
Work Control Only - Internal Routing
Issued
___RM ___ SE ___ TM ___ UA
___ Other
WORK REQUEST NO: _______________________________
Pending ___ PR ___ PE ___ PP ___ SP
____________________
WORK REQUESTED:
DATE: _______________
Planner
Maintenance/Repair
Service
Rekey
New Work (Construction/Alteration)
Requesting Dept: ___________________________________
Requestor: _____________________________________
Email Address for Work Order Notification: ________________________________________________________________
Location of Work (Building or Area): ________________________________________________
Room #: ____________
Description of Work: (Attach sketch for clarification. State purpose if construction.)
Completion Date Requested By: _______________ (Explain urgency/date needed if less then 30 days): ______________
_________________________________________________________________________________________________
Contact for Details:
Alternate Contact:
Name: _______________________________________
Name: __________________________________________
Phone (extension): ______________________________
Phone (extension): _________________________________
Email: ________________________________________
Email: ___________________________________________
Cost Recovery: (Billable Work Including Construction/Alteration/Auxillary Service)
Change in Utilization of Space?
YES
NO
If yes, must be approved by the Standing Committee on Space and Facilities. Direct questions to Facilities Management at 826-4111.
Cost Estimate Requested?
Yes
If Yes,
Project Budqet Only
Formal Cost Estimate
No
Proceed Time & Material.
Not to Exceed $ _______________
Account:
Fund:
Dept:
Program:
Class:
Project:
Please Provide
Chartfield
String
Department to be Charged: _____________________
Account No: __________________________________
APPROVED BY:
_________________________
__________________________
________________________
______________
Print Name
Title
Signature
Date
_____________________________
_____________
_________________________________
______________
Dean or Dept. Director Signature
Date
Building Coordinator
Date
if Construction
Signature for Lock Change
Moving Required: Coordination of any moving required to complete work is the responsibility of the requesting department.
Furniture/Equipment Boxes
Contact: Distribution Services
Phone: 826-3932
Telephone/Computers
Contact: Network Support
Phone: 826-5000
Send completed form to Work Control Center at Plant Operations. Attach copy of Standing Committee on Space & Facilities
Approval as Appropriate.
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Parent category: Business