Attach 4 - MW Outage SHEET blank.pdf
PDF 36 KB Posted
- Attached to
- ROADWAY & SITEWIDE IMPROVEMENTS Federal contract opportunity
- Solicitation number
- 70FA5025R00000012
About this file
This document is a Utility Shutdown/Fire Alarm Testing Request form for Mount Weather Facilities Management. The form requires a minimum of 5 working days' notice for shutdown requests and allows for detailed specification of utility and equipment shutdowns, including options for chilled water, domestic water, steam, heating/cooling, fire alarms, electrical systems, and other utilities. The form provides fields to document the shutdown details, including affected buildings, shutdown and restoration dates/times, reason for shutdown, and on-site contact information. Requests must be emailed to MWOPSMAIN@fema.gov, with questions directed to PCB at extension 2-2156. The form was revised on October 16, 2009, and is designed to formally track and approve utility system interruptions at the Mount Weather facility.
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Text version
Revised October 16, 2009
Mount Weather Facilities Management
Utility Shutdown/Fire Alarm Testing Request
A MINIMUM OF 5 WORKING DAYS NOTICE IS REQUIRED FOR SHUTDOWN REQUESTS.
Maintenance W/O # Service W/O #
Contract #
Request permission to shut down the following utility(ies) and or equipment:
Chilled Water Domestic Hot Water Domestic Cold Water Steam/Condensate Industrial Hot Water Exhaust Heating/Cooling Compressed Air (lab or control)
Gas Fire Alarm Fire Alarm Testing Electrical (high or low voltage) Fire Sprinkler System(s) Sanitary Waste Other
Details:
Building(s) affected:
Area of building(s) affected:
Shutdown Information Date: Time:
Restored Information Date: Time:
Reason for shutdown:
Contact on site during shut down:
Requested by: Date:
DO NOT WRITE BELOW THIS LINE
Date Received by:
Shop’s verified and approved / NOT approved by: Date:
Request approved / NOT approved by: Date:
Please e-mail request to MWOPSMAIN@fema.gov. For any questions regarding Shut Down request procedures:
please call PCB @ 2-2156.
| Facilities Management |
| Utility Shutdown/Fire Alarm Testing Request |
| A MINIMUM OF 5 WORKING DAYS NOTICE IS REQUIRED FOR SHUTDOWN REQUESTS. |
| DO NOT WRITE BELOW THIS LINE |
| Chilled Water: Off |
| Domestic Hot Water: Off |
| Domestic Cold Water: Off |
| SteamCondensate: Off |
| Industrial Hot Water: Off |
| Exhaust: Off |
| HeatingCooling: Off |
| Compressed Air lab or control: Off |
| Gas: Off |
| Fire Alarm: Off |
| Fire Alarm Testing: Off |
| Electrical high or low voltage: Off |
| Fire Sprinkler Systems: Off |
| Sanitary Waste: Off |
| Other: Off |
| approved: Off |
| NOT approved by: Off |
| undefined: |
| Date: |
| approved_2: Off |
| NOT approved by_2: Off |
| undefined_2: |
| Date_2: |
| Maint WO #: |
| Serv WO #: |
| Contract #: |
| Details: |
| Affected Buildings: |
| Affected Areas: |
| Start Date: |
| Start Time: |
| End Date: |
| End Time: |
| Justification: |
| On Site POC: |
| Requestor: |
| Request Date: |
| O&M Date RCVD: |
| PCB Reciever: |
File details come from the government source that posted it. Updated .