E-UA by fanzhongqing


									User Activation                                                                                                                                      Team 3 Practicum: Facilities and Plant CS renovation

                                                                               University of Michigan Medical School
                                                                             Facilities Management and Planning (FMP)

                                                                                   User Activation (UA)
                   Requested by:                                                                                                                       Date:

              Work Request No.                                                                            New Work Order, please fill out the information below.

                                            Short Code              OR            Fund                       Org. Code                     Class                      Program           Project/Grant

                                        Authorized Printed                Authorized Signature               Phone No.              E-mail address

Building & Room Number:                                                                                     Project Name:

Items                              Needed (Y/N)?                         Items                            Needed (Y/N)?            Items                        Needed (Y/N)?
Connect Utilities                                                        Installation of                                           Misc.
    Lab Gas *                                                                  Tank Restraint                                              Moving
    Lab Vacuum                                                                 Water Polisher (MilliQ)                                     Custodial
    Lab Compressed Air                                                         Additional Shelving                                         Furniture
    Lab CO2                                                                    Bio Safety Cabinet                                          OSEH/Rad Safety
    Lab Water                                                                  Fume hood                                                   Card Access
    Lab DI Water                                                               Fridge/Freezer                                              Keying/Keys
    Electrical Connection                                                      Incubator (drained)                                         Signage
    HVAC                                                                       Centrifuge                                                  Autoclave Training
    Others please list below                                                   Similation Counter                                          Property Control
                                                                               Developer                                                   Training (misc.)
                                                                         Others please list below                                          Phone/IT
* See OSEH for gas in BSC's                                                                                                                Property Dispo.

                                                                                      Description of Request

                                   Is an estimate needed, Yes/No?                                    if yes, then please STOP and send this request to FMP.
                                                                                                     if no, then please review and sign below approving change(s)*

Estimated Amount $:                                                                                                 Additional days to complete:

Prepared by :                                                                                                                                                                   Date:
(Const. Service)                             Signature                                                                Print Name

FMP Project Coordinator :                                                                                                                                                       Date:
                                               Signature                                                              Print Name

Department/Division                                                                                                                                                             Date:
Representative                                 Signature                                                              Print Name

                               Please fax completed form to FMP, Projects at 763-0299 or email to Med.School.Facilities@umich.edu. Subject Line: Projects

*This approves the time, material and schedule impacts to complete this work. You will be notified by a FMP staff on the cost and schedule

                                                                                  Date Received:                                      UAF Number:
      FMP Use Only                                                                  Assigned To:                                            Date:
                                                                                    Project Title:


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