UTHSC-H
UTILITY SHUTDOWN REQUEST FORM
Project Name:
Current Date:5/18/2013
Current Time:23:44
Project Number:
*
Start Date:
*
Start Time(military):
*
End Date:
*
Building:
CYC Cyclotron
CDC Child Development Center
DBB Dental Branch Building
HCPC Harris County Psychiatric Center
IMM Institute for Molecular Medicine
MSB Medical School Building
MSI Mental Science Institute
NSH New Student Housing
OCB Operations Center Building
RAS School of Public Health
REC Recreation Center
RRF (Research Replacement Facility
SFA Student Faculty Apartments
SON-School of Nursing
UCT University Center Towers
UTPB University of Texas Professional Building
*
Floor Affected:
Sub Basement
Basement
Ground
Floor - 1
Floor - 2
Floor - 3
Floor - 4
Floor - 5
Floor - 6
Floor - 7
Floor - 8
Floor - 9
Floor - 10
Floor - 11
Floor - 12
Floor - 13
Floor - 14
Floor - 15
Floor - 16
Floor - 17
Floor - 18
Floor - 19
Floor - 20
Floor - 21
Floor - 22
Floor - 23
Floor - 24
Floor - 25
Floor - 26
Penthouse
Hold down CTRL button for multiple floors.
Room Locations:
*
UT Representative :
Company:
Email Address:
Position:
*
What system(s) are to be shut down?
This shutdown is required in order to:
GC Rep:
Position:
*
Company Doing Work:
*
Phone:
*
Person Doing Work:
Pager:
Number of hours needed to do work:
Requested Shutdown Date:
Do you agree to the following? (I agree box)
This request must be submitted by UTHSC-H Project Manager (in order to allow Facilities Operations' personnel to investigate and coordinate this request) a minimum of five (5) days prior to the requested shutdown date. Facilities Operations' shutdown coordinator will return to the UTHSC-H Project Manager a written copy of the scheduled time and day for the shutdown a minimum of two (2) days prior to the shutdown.
I agree to the above terms