Attachment 30-Work Request.pdf
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- Attached to
- Training Support Services
- Solicitation number
- 70LART25RPFB00006
About this file
This is a work request form template used by the Office of Artesia Operations (OAO) for requesting facility-related work or modifications. The form consists of eight sections that track the approval and processing workflow, from initial request through final authorization. Key sections include Request Originator Information (requiring details like building/room number and phone extension), work description (with measurements and sketches when applicable), work location, requested completion date, and justification (with a checkbox for safety/health issues).
The form requires multiple levels of approval signatures, including supervisor approval, second-line supervisor/agency representative approval, Master Plan and Construction Division review, Contracting Officer/COTR sign-off, and final AD/OAO approval and funding. Administrative tracking elements include work request number, facilities/term contract details, clerk entries for logging and funding codes, and capitalization reporting requirements. The form indicates that all processing should be sent to Building 192, Room 113.
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Text version
PRIORITY (OAO USE) WORK REQUEST
OFFICE OF ARTESIA OPERATIONS
DATE ORIGINATOR'S NAME AND AGENCY/BRANCH BLDG # :
ROOM # :
DESCRIPTION OF WORK REQUESTED: (PROVIDE MEASUREMENTS AND ATTACH SKETCHES WHEN POSSIBLE)
Name/Title: Signature: Date:
Name/Title: Signature: Date:
Name/Title: Signature: Date:
Term Contract:
Name/Title: Signature: Date:
DATE RECEIVED:
WR LOG ENTRY WR FILE CREATED FUNDING CODE MOM ENTRY
COTR/PM: Signature: Date:
DATE RECEIVED: PROJECT TITLE:
PRELIMINARY CAPITALIZATION REPORT SUBMITTED:
ELECTRONIC AS-BUILT FILES RECEIVED: FINAL CAPITALIZATION REPORT SUBMITTED:
AD/Designee: Signature: Date:
(REV 8/10) PAGE 1 OF 2
Work Request # MCD
PHONE #/EXTENSION
Section I - Request Originator Information
Facilities Contract:
Section III - Second Line Supervisor, Agency Representative (Chief/ASAC) Approval
(Continue on Reverse/Page 2)
DESCRIBE WHERE (LOCATION) WORK REQUESTED IS TO BE PERFORMED: REQUESTED COMPLETION DATE:
JUSTIFICATION: CHECK HERE IF SAFETY/HEALTH ISSUES:
(Continue on Reverse/Page 2)
(Print)
(Print)
(Print)
(Print)
Section VII - Assignment (COTR / MCD Project Manager)
Section VI - Clerk Entries
Section V - Contracting Officer / COTR
Section IV - Master Plan and Construction Division
* FOR PROCESSING SEND TO BUILDING 192, ROOM 113
(Print)
Section II - Supervisor Approval
Section VIII - AD, OAO Approval Decision and Funding
(Print) Funding Approval #:
File details come from the government source that posted it. Updated .