Facilities Management Shutdown Request Form

Please complete and submit this form to request that Facilities Management Customer Relations send an email notification to occupants in your building who may be affected by maintenance activity or a system shutdown.

Your Division/Unit *
Work Order # *
Contact Phone Contact Phone * - ### - ### ####
Contact Name Contact Name * First Last
Contact Email *
Affected Location (please specify) *
Is the start date less than two weeks from today and is this a routine notification? (If this is an emergency or affects multiple buildings, e.g., flooding, fire, gas leak, etc., click “No.” If this is routine and less than two weeks away, click “Yes.”) *

Is the start date less than two weeks from today and is this a routine notification? (If this is an emergency or affects multiple buildings, e.g., flooding, fire, gas leak, etc., click “No.” If this is routine and less than two weeks away, click “Yes.”) Yes No
Start Date Start Date * / MM / DD YYYY
Start Time Start Time * : HH MM AM/PM
End Date End Date * / MM / DD YYYY
End Time End Time * : HH MM AM/PM
Is this work continuous or being performed daily? *

Is this work continuous or being performed daily? Continuous Performed daily
System to be Shutdown/Impact *
Maximum of 250 characters allowed. Currently Entered: 0 characters.
Purpose of Shutdown/Notification *
Maximum of 1000 characters allowed. Currently Entered: 0 characters.
How will this shutdown affect building occupants//campus community (e.g., alternate facilities, space heater needed, other accommodations)?
Maximum of 1000 characters allowed. Currently Entered: 0 characters.
Special Instructions
Maximum of 500 characters allowed. Currently Entered: 0 characters.
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Please review the information above for accuracy. *

Please review the information above for accuracy. I have verified that this information is correct.
If you have any questions or concerns, please contact the Facilities Management Customer Relations Help Desk at (858) 534-2930.