!"#$%$&$'()*+,$-$#"&$+.)/'01'(&!
University!of!Hawaii!at!Hilo!
(For!all!altering,!repairing,!improving,!or!demolishing!to!any!University!structure)!
(Maintenance!&!Logistic!Work;!Use!Auxiliary!Services!Job!Order!Request!Form)
!
Revised!4/5/2016!
2'3"4&5'.&)/'01'(&6!
From:! Department:! Phone:!
Description:!
Justification:!
Required!Completion!Time:! Date:! 3!Months! 6!Months! 1!year!
!Utility!Required:! !Electricity!
!Water! !Telephone! !Data! !Gas! !None! !!Other:!
2'3"4&5'.&)7334+8"%6!
Approved!–!forward!to!Dean’s!Office! Available!Funding:!
Not!Approved!–!Return!to!Requester! Signed!by!Chair:! Date:!
Comments:!
94+:4"5)/'8$';)(for!program!requirements,!space!management!funding,!etc.):!
<+%%':')=+4)'01$8"%'.&)+--$#'>)7334+8"%6!
Approved!–!Forward!to!Vice!Chancellor!(or!equivalent!office)!for!approval:!
Not!Approved!–!Return!to!College! Signed!by!Dean:! Date:!
Comments:!
?<)7334+8"%6!
Approved!–!Forward!to!Auxiliary!Services!for! Review!&!Process:!
Not!Approved!–!Return!to!College! Signed!by!VC:! Date:!
Comments:!
71@$%$"4A)B'48$#'()/'8$';)C)7#&$+.6)D.8$4+.5'.&"%)
E'"%&F) C)B"-'&A)<+.#'4.(6!
Is!Hazardous!Material!involved?!
Yes! No!
N/A!
B'#14$&A)<+.#'4.(6!
G3'4"&$+.)C)*"$.&' . " . # ' )<+.#'4.(6!
H.IE+1(')/'3"$4) No! If!No,!forward!to!Office!of!Facilities!Planning!&!Construction.!
Yes!!!!!!!If!Yes,!continue!as!non-construction!project!
Estimated!Completion!Date:!
Funding:! Program! Auxiliary!Services! Others:!
Action:!
!
Proceed! Pending!Available!Funding! Return!for!Revision!
See!attached!Comments!and/or!Recommendations!
2$4'#&+4J)71@$%$"4A)B'48$#'(:!
Date:!
94+:4'((6!
Final!Approval!Date:!
Estimated!Completion!Date:!
Current!Status:! Date:!
Actual!Completion!Date:!
Actual!Cost:! _!
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