Lab Ventilation Shut-Down Request

The following form should be submitted whenever work being performed will remove, or potentially interrupt service on HVAC equipment that serves critical lab space. The Shutdown Request must be submitted to EHS at least 3 business days prior to the requested shutdown date to allow time for coordination with Lab Occupants. Longer advance notice may be necessary for complex or involved shutdown requests.

Please call in all emergencies and urgent requests: Environment, Health and Safety 608-209-8466 or 608-712-9480.

Please fill out and submit the following form.

Lab Ventilation Shut-Down Request

Requested Work Start Date*
MM slash DD slash YYYY
Requested Work Start Time*

: Hours

Minutes

AM/PM
Requested Work Stop Date*
MM slash DD slash YYYY
Requested Work Stop Time*

: Hours

Minutes

AM/PM
Requester's Full Name*
First Last
Lead Trades Person's Full Name*
First Last
Department*
Phone or Pager Number*
Email*
Building Code/Building Name*
Fan PM Number/Fan Name*
Description of Maintenance Service Requested
Name
This field is for validation purposes and should be left unchanged.