J-9 Attachment IX Workstation Checklist.doc

IWS/LAN Single Workstation Move Version – 5.1

Submit to ^LAN Moves or LAN.Moves@ssa.gov

Workstation Move Checklist

* SSA is required by contract to give the vendor a 45 day notice of our intent to relocate equipment Complete this checklist if you are requesting to move workstation or equipment from one location to another, where the office isn’t moving. If your office is moving there is no need to complete this checklist in addition to the “Office Relocation and Equipment/LAN Moves Checklist”. If you are requesting multiple workstation and/ or equipment moves to multiple locations, you must complete a checklist for each location. If you have questions about this form please contact the Action Center at (410) 965-2500.

Today’s Date: 03-25-09 Current Office Location Information

Start Date: 3/26/09 Time: 10:30 FORMCHECKBOX

AM FORMCHECKBOX

PM

Site Code: E12 Region: FORMDROPDOWN

ROCC: FORMDROPDOWN

Office Component: FORMDROPDOWN

OS: FORMDROPDOWN

Address: 310 W. Wisconsin Ave.

Street #, Name East Tower, Suite 600 Room or Suite Milwaukee WI 53207 City/State/ County/ Zip Is this a Temporary Move: Yes FORMCHECKBOX No FORMCHECKBOX

If the Workstation(s) will remain at the temporary site longer than 30 days a new checklist for the return must be submitted If so Return Date: Time: FORMCHECKBOX

AM FORMCHECKBOX

PM

Nearest Street/Intersection: Estimated Distance of Move:

Current Office Contact Name Office Phone

Cell Phone

Primary Contact:

Den Done 866 861 3427 x 1234 Alternate Contact:

Workstation/ Equipment Information VOIP Site: Yes FORMCHECKBOX No FORMCHECKBOX

Additional Requirements or Comments:

Number of Workstations: 3 Ring# BB4 Topology: Ethernet FORMCHECKBOX Token Ring FORMCHECKBOX (select one) EWD Workstation : Yes FORMCHECKBOX No FORMCHECKBOX if yes, please complete Part II Radia Client Site: Yes FORMCHECKBOX No FORMCHECKBOX

New Office Location Information

Start Date: 4/25/09 Time: 0345 FORMCHECKBOX

AM FORMCHECKBOX

PM Return Checklist required for Temporary Moves of 30 Days or More Site Code: E12 Region: FORMDROPDOWN

ROCC: FORMDROPDOWN

Office Component: FORMDROPDOWN

OS: FORMDROPDOWN

Address: Same as above

Street #, Name Room or Suite City/State/ County/ Zip

Nearest Street/Intersection: Fort St

New Office Contact Name

Office Phone

Cell Phone

Primary Contact:

Same as above Alternate Contact:

Workstation/ Equipment Information VOIP Site: Yes FORMCHECKBOX No FORMCHECKBOX

Additional Requirements or Comments:

TASK ORDER TO0002

-Covert existing 3 VOIP workstations to Ethernet. Ethernet cards are at the office to be installed by vendor. NTE 4 hours.

Ring# 6 Topology: Ethernet FORMCHECKBOX Token Ring FORMCHECKBOX (select one) Radia Client Site: Yes FORMCHECKBOX No FORMCHECKBOX

Re-imaging of workstation required? Yes FORMCHECKBOX No FORMCHECKBOX

If yes, what will be the re-image source? disk

Part II EWD Specification

Please be advised a separate checklist must be completed for multiple EWD request.

Employee Impairment: FORMDROPDOWN

Specify any additional EWD equipment to move:

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Last updated 5/02/08