Completed form must be submitted by e-mail to the assigned JDAC Engineer and JDAC
Facilitator
.
Revised Octob
May
2014
October 2014
JDAC’s Support Request Form
One Activity per
Request
Project Title: PCN:
WMATA JDAC Engineer: WMATA JDAC Facilitator:
Project Start Date:
Activity Start Date/Time:
SSWP Number (If applicable):
Project End Date:
Activity End Date/Time:
Expiration Date:
Type of Request/Duration: Single Day Request Multiple Day Request Continuous Request
Description of Work/Equipment:
Crew Size:
Location: Mainline Non-wayside Yard Yard Lead
Track Access: Yes No Identify the work location:
From (Chain Marker or YCR)
Power Outage Type: Supervisory Red Tag None LOTO(if required)
Any Piggybacking Restrictions: Yes No
If yes, please explain:
State any unusual circumstances:
Meeting Location:
Authorized Representative’s Typed Name:
Authorized Representative’s Signature:
Completed by WMATA JDAC Engineer
Date
Received:
Escort Group:
SMNT:
TRST:
ELES PLNT Other:
Charge Code:
** Work cancellation requires written notification with a minimum of two (2) business days’ notice. **
**WMATA's support charges are paid by the shift not by the
hour.**
Submit the completed form by e-mail to the assigned JDAC Engineer and JDAC Facilitator.
