ATTACH12_Master Utility Outage.PDF

Service Request Number:

Work Task Number:

UTILITY OUTAGE REQUEST

DATE:

CHECK OUTAGE TYPE: Electrical Water Steam Chilled Water Other

IF OTHER, EXPLAIN:

FACILITY NUMBER(S):

FACILITY MANAGER SIGNATURE AND ANY REQUIRED USER COORDINATION

LABOR RELATIONS COORD REQUIRED: YES NO

REQUEST OUTAGE BEGINNING:

ENDING ON:

(TIME) AND

(TIME)

SHOP COORDINATION

INITIAL AS NEEDED

Facilities Super Alarms Electrical Power Production Fire Dept

Heavy Repair Super Environmental Controls

HVAC

Structures Security Forces

Infrastructure Super Water/Fuels Water Plant Steam Plant Base Comm

Other:

78 CES/CEPC (SERVICE CALL MUST COORDINATE ON ALL OUTAGES AND RECEIVE A COPY OF

SIGNED OUTAGE REQUEST)

78 CES/CL OUTAGE IS APPROVED/DISAPPROVED:

Outage meetings are held Wednesdays at 1030 in building 1555. Outages typically required to be scheduled at least 14 days in advance.

Service request numbers are to be provided by facility manager of affected facility

REASON FOR

OUTAGE:

REQUESTER:

PROJECT NUMBER:

COMPANY:

PHONE NUMBER:

PROJECT/CONTRACT MONITOR NAME:

SIGNATURE:

PHONE NUMBER:

(DATE) AT