Attachment 03 Service Call Work Authorization.pdf
PDF 136 KB Posted
- Solicitation number
- SP4702-26-R-XXXX
- Issued by
-
Defense Logistics Agency
About this file
This is a Service Call Work Authorization form used to document and authorize repair work on facility systems, primarily fire safety and mass notification systems.
The form captures essential information about service calls including call classification (Emergency, Urgent, or Routine), notification details, and system identifiers for Fire Sprinkler Systems, Fire Alarm Systems, and Mass Notification Systems. It requires identification of the building and bay number where work will occur, a brief problem description, and detailed specifications of work to be performed. The form includes a checkbox to determine whether system impairment is required, with instructions to complete an accompanying Impairment Worksheet if necessary. The Contracting Officer or Contracting Officer Representative must authorize the work by signature and date, confirming the contractor will furnish all required labor and materials, complete any necessary supporting documentation, and provide appropriate notifications to personnel before and after repairs.
The lower section documents actual work completion, requiring the contractor to record the date and time work started and completed, provide a description of completed work and materials used, report hours expended and equipment/materials costs, identify the appropriate CLIN number for billing, and obtain the Contractor's Certifying Official signature with date. This form serves as the primary authorization and documentation tool for tracking contractor repair efforts on federal facility systems.
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Text version
Emergency:
Urgent:
Routine:
Bay Number:
Brief Description of the Problem:
Work to be Performed:
Does this work require system impairment? Yes No If yes, complete Impairment Worksheet
Date:
Time Work Started:
Date:
Date Work Started: Date Work Completed:
Time Work Completed:
Fire Alarm System Number:
Phone Number:
Requesting Individual:
Mass Notification System Number:
Contractor's Certifying Official Signature:
Fire Sprinkler System Number:
Estimated Cost for Routine Repair Effort
Service Call Work Authorization
Cost of Equipment and Materials:
Number of Hours Expended: CLIN Number to be Charged:
Provide brief description of work completed and materials/parts used during this effort.
CALL CLASSIFICATION
Notification Time:
Notification Date:
Building Number:
Government Work Authorization I hereby authorize the repair work herein set forth to be done by the contractor. The contractor shall complete the following as necessary:
- Furnish all labor required to execute this work.
- Furnish all necessary material required for this work.
- In the event that system impairment is required, complete Impairment Worksheet.
- Complete any other forms required to safely carry out authorized work.
- Notify additional personnel as required prior to starting and upon completion of the required repairs.
X________________________________________ Date:_________________ (Contracting Officer or Contracting Officer Representative)
File details come from the government source that posted it. Updated .