EFTA00126230.pdf

FBOP WO Tech Facility Minor Work Request NYM TO: FACILITY MANAGER FROM: NYM Footties • Feathers THRU: Facility Manager. HS,/ _ (Entered by:) (Department) (Phone) (Department Head Signature) Site: NYM Building: 3RD Location: LIEUTENANT OFF - LIEUTENANT OFF Work Location: SIS Corn Tech You aro requested to perform the following work: DVR Failure it 2 DVR Failure # ltDVR falure # 2 if Applicable. ensure all safety precautions are fanned b inctude but not limited to tockouttragout. Confined Space Fatty. a Fail Motecton" Date Active: 7119(2019 Status: ACTH TMS No.: 10481 You are authorized to perform the above work: To Foreman: CM01 - CMOI - Skill: Communication IF WORK ORDER WAS CREATED FROM A PM, ENTER PM WORK ORDER ft List below all materials used: Pescrlotion fa° tifteklykie fil .5 roar Priority No: 2 Facility Manager. (AtMang °nature) Warden's signature for greater than $1e000 chiontity Iliad Unit Price Tehl Grand Total: If Applicable, ensure that the equipment bin a MWI label afitad In deer view and legible. PAWI o Asbestos Abatomont is required or has been completed. K FITARA process is required. Completion Comments: Foreman's Total Hours: 2'0 Date Contented: Upon completion of work, complete form and return to the Facility Manager. H Signet e Re94(41 (10744„telod PrW6 EFTA00126230 FBOP WO Tech Facility Minor Work Request NYM 10481 Ch101 TO: FACILITY MANAGER FROM: NYM Facilities • (Entered ter) Site: NYM 13tredimip 3RD You are requested to perform the following work OVR II 2 DVR Faule a 1/ DVR tadise # 2 Facilities (Department) (Phone) DMU: Facility Manager //SU (Department Head Signature) Location: LIEUTENANT OFF - LIEUTENANT OFF Work Location: SIS Corn Test If Applicable, eneuro ell safety precautions ere followed to Include but not limited to '' Lockout/Tag out. Confined Space Entry. & Foll Date Active: 7/19/2019 'MIS No.: 10481 You are authorized to perform the above work: To Foreman: O401 -CMOs Skill: Communication IF WORK ORDER WAS CREATED FROM A PM, ENTER PM WORK ORDER List below all materials used: poscrlotion Status: CM P LT Priority No: Facility Manager: 2 (Authorizing Signature) Warden's signature for greater than 510,000 Qtlagliti nti Llnit Price Eta Grand Total: If Applicable, ensure that the equipment hase MWI label affixed In clear view ond legible. MWI e: K Asbestos Abatement Is required or has been completed. K FITARA process Is required. Completion Comments: Foreman's Total Hours: Date Completed: 8/2612019 Upon completion of work, complete form and return to the Facility Manager. Staff Signature 1 EFTA00126231