work request form facilities management division - NASA
work request form facilities management division - NASA
work request form facilities management division - NASA
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WORK REQUEST FORM<br />
FACILITIES MANAGEMENT DIVISION<br />
GODDARD SPACE FLIGHT CENTER<br />
CUSTOMER’S INTERNAL TRACKING #<br />
FMD WORK REQUEST 3<br />
INSTRUCTIONS FOR COMPLETING THIS FORM ARE ON THE SECOND PAGE<br />
1a. CUSTOMER NAME: 1b. CODE 2. TO:<br />
4.<br />
LOCATION<br />
OF WORK:<br />
CODE 222.1/WORK RECEPTION<br />
3. TODAY’S DATE:<br />
BUILDINGS(S) ROOM(S)/OTHER: EQUIPMENT ID # (IF KNOWN) 5. NEED DATE<br />
6. DESCRIPTION OF WORK:<br />
ATTACHMENT? YES<br />
NO<br />
7. JUSTIFICATION:<br />
FOM REVIEW (INITIALS/DATE):<br />
BLDG MGR REVIEW (INITIALS/DATE):<br />
8. FOR INFORMATION, CONTACT: CODE: EXT.: BLDG.: ROOM:<br />
9.<br />
FUNDING DATA<br />
(SEE INSTRUCTIONS)<br />
APPROPRIATION: JOB ORDER NUMBER: BUDGET LINE ITEM: FISCAL YEAR:<br />
APPROPRIATION: JOB ORDER NUMBER: BUDGET LINE ITEM: FISCAL YEAR:<br />
10.<br />
AUTHORIZING<br />
SIGNATURE: DATE: PRINTED/TYPED NAME/TITLE/CODE:<br />
OFFICIAL<br />
(SEE INSTRUCTIONS)<br />
11.<br />
DIRECTORATE<br />
SIGNATURE (FCC MEMBER/AUTHORIZED REP): DATE: NO. & TITLE FROM FCC LIST (IF APPLICABLE):<br />
FCC REVIEW<br />
(SEE INSTRUCTIONS)<br />
FOR FMD USE ONLY BELOW THIS LINE<br />
12. APPROVAL: 13. CONCURRENCE: 14. PRIORITY: 15. WORK TYPE: 16. CATEGORY: 17. CM/CC/TAM: 18. SECTION:<br />
19. SHOP/SPEC.CASE CODE: SHOP/SPEC CASE CODE: SHOP/SPEC CASE CODE: SHOP/SPEC CASE CODE: SHOP/SPEC CASE CODE:<br />
GSFC 16-48 (11/96) All previous versions of GSFC <strong>form</strong>s 16-35 and 16-47 are obsolete.
FMD SERVICES REQUIRING A WORK REQUEST FORM<br />
At Goddard Space Flight Center-Greenbelt, the following services require a Work Request <strong>form</strong>: planning, design, and<br />
direction for the construction of all new <strong>facilities</strong> and modification of existing <strong>facilities</strong>; and non-repair maintenance<br />
services such as painting, special custodial services, and fabrication, etc. ALL ROUTINE REPAIRS, TROUBLE CALLS,<br />
AND PEST CONTROL SERVICES SHOULD BE OBTAINED BY CALLING THE WORK CONTROL CENTER AT<br />
x6-5555.<br />
Note: At WFF, all services must be obtained by submitting an FMD Work Request <strong>form</strong> to the Facilities Management<br />
Branch, Code 228.<br />
INSTRUCTIONS FOR COMPLETING THE WORK REQUEST FORM<br />
Be sure to fill in all blocks pertaining to your <strong>work</strong> <strong>request</strong>. If the block does not apply to you, write in “N/A” so that FMD is<br />
assured that it was not overlooked. Thank you.<br />
BLOCK 1:<br />
BLOCK 2:<br />
BLOCK 3:<br />
BLOCK 4:<br />
BLOCK 5:<br />
BLOCK 6:<br />
BLOCK 7:<br />
BLOCK 8:<br />
BLOCK 9:<br />
BLOCK 10:<br />
BLOCK 11:<br />
BLOCK 12<br />
THRU 19:<br />
Enter the name and code of the original <strong>request</strong>er (the individual benefiting from the <strong>work</strong>).<br />
Address where completed Work Request <strong>form</strong> should be forwarded.<br />
Today’s date.<br />
Address where <strong>work</strong>/service is to be delivered.<br />
Enter the date by which you need <strong>work</strong>/service completed. Justify this date in Block 7, below. DO NOT<br />
enter vague timeframes such as “ASAP.” Your <strong>work</strong> <strong>request</strong> will be scheduled in turn if a date is not<br />
provided. Need dates for projects may be negotiated between FMD and the <strong>request</strong>er.<br />
Describe the specific <strong>work</strong> you want done. Use an additional sheet if more space is needed.<br />
Explain why you need the <strong>work</strong> done and why you need it done by the date indicated in Block 5. If the<br />
proposed <strong>work</strong> is directly related to a flight, engineering or scientific project, identify the project. Have<br />
your Facility Operations Manager (FOM) and Building Manager review the Work Request and initial in the<br />
spaces provided. (FOM’s and Building Managers are listed in the GSFC Telephone Directory.)<br />
Identify your point of contact that can provide additional details regarding the scope of <strong>work</strong>. This should<br />
be the person that is most knowledgeable about the project, which will be the point of contact for the life<br />
of the project, and the person to whom FMD will send project status reports/letters.<br />
If your organization is paying for the proposed <strong>work</strong>, enter your funding data; otherwise, simply insert<br />
“NA.” FMD Resources Office will confirm funds availability. Be certain that your job order number is<br />
appropriate for the type of <strong>work</strong> being per<strong>form</strong>ed.<br />
Authorizing official must be at the Branch Head level or higher.<br />
Work Requests which are expected to exceed $2.5K should be authorized by your Directorate Facilities<br />
Coordinating Committee (FCC) member. Customer-funded projects do not require FCC approval.<br />
DO NOT write in these blocks—for FMD use only.<br />
A confirmation of your <strong>work</strong> <strong>request</strong> will be forwarded to you. Please be sure to retain it for reference.