Atch__18_-_BLANK_SAMPLE_Master_Utility_Outage.pdf

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

(DATE) AT REQUEST OUTAGE BEGINNING:

SIGNATURE:

ENDING ON: (DATE) AT (TIME)

REASON FOR

OUTAGE:

REQUESTER:

PROJECT NUMBER:

COMPANY:

PHONE NUMBER:

PROJECT/CONTRACT MONITOR NAME:

PHONE NUMBER:

SHOP COORDINATION Facilities Super Infrastructure Super Utilities Super INITIAL AS NEEDED Alarms Industrial Mechanical Utilities

Interior HVAC Fire Dept Exterior Zone 1 Other Power Production

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

SIGNED OUTAGE REQUEST)

OUTAGE IS APPROVED/DISAPPROVED:

This form effective 03/17/2006

(TIME) AND

78 CES/CL

After electronically completing top portion of form, print for coordination initials and approval signature.

UTILITY OUTAGE REQUEST

DATE:

CHECK OUTAGE TYPE:

IF OTHER, EXPLAIN:

FACILITY NUMBER(S):

FACILITY MANAGER SIGNATURE AND ANY REQUIRED USER COORDINATION

LABOR RELATIONS COORD REQUIRED:

YES

NO

(DATE) AT

REQUEST OUTAGE BEGINNING:

SIGNATURE:

ENDING ON:

(DATE) AT

(TIME)

REASON FOR

OUTAGE:

REQUESTER:

PROJECT NUMBER:

COMPANY:

PHONE NUMBER:

PROJECT/CONTRACT MONITOR NAME:

PHONE NUMBER:

SHOP COORDINATION

Facilities Super Infrastructure Super Utilities Super

INITIAL AS NEEDED

Alarms Industrial Mechanical Utilities Interior

HVAC

Fire Dept Exterior Zone 1 Other Power Production

78 CES/CEPC

(SERVICE CALL MUST COORDINATE ON ALL OUTAGES AND RECEIVE A COPY OF

SIGNED OUTAGE REQUEST)

OUTAGE IS APPROVED/DISAPPROVED:

This form effective 03/17/2006

(TIME) AND

78 CES/CL

After electronically completing top portion of form, print for coordination initials and approval signature.

UTILITY OUTAGE REQUEST

Preferred Customer Normal.dot william.fowler Microsoft Office Word

3/10/2006 1:32:00 PM

3/10/2006 1:30:00 PM

3/10/2006 1:32:00 PM

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