Attachment 30-Work Request.pdf
PDF 65 KB Posted
- Attached to
- Transportation Service FLETC Artesia, NM
- Solicitation number
- 70LART25RPFB00007
About this file
This document is a Priority Work Request form used by the Office of Artesia Operations (OAO) for requesting and tracking facility-related work projects. The form consists of eight sections that guide the approval and execution process, from initial request through final authorization and funding.
The form requires detailed information including the originator's information (name, agency/branch, building/room number, phone extension), description and location of requested work (with measurements and sketches if applicable), justification, and a checkbox for safety/health issues. The approval process flows through multiple levels 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 decision. The form also tracks administrative details such as work request number, facilities/term contracts, funding codes, capitalization reports, and as-built file documentation. Work requests must be processed through 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 #:
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