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SPACE CHANGE REQUEST Appendix 8.3 Instructions: Refer to (California State University, Los Angeles)

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Number: 007
Page: 12 of 15
Appendix 8.3
SPACE CHANGE REQUEST
Instructions: Refer to ADM 007, pages 13-15. Use DocuSign to route form and checklist for
signatures. Academic Affairs Space Advisory Group (AASAG) reviews and approves all AA space
requests. This is then reviewed by Environmental Health and Safety (EHS) and Facilities Services (FS)
prior to review by the Space Management Subcommittee (SMS). Upon SMS review and vote,
recommendations are routed to the president for final review.
ORGANIZATION UNIT
EXTENSION
DEPARTMENT HEAD (Please Print)
SIGNATURE
DATE
SPACE REQUEST:
RATIONALE FOR REQUEST (Please attach additional pages):
HOW IS THIS NEED CURRENTLY BEING MET?
ITEMIZE BUDGETED POSITIONS (Including source of funding) that will use proposed space:
ITEMIZE RENOVATION EXPENSE (attach cost estimate from F
acilities Services if appropriate and
indicate funding source):
Date of Planned Occupancy:
ITS Approval (as appropriate)
Date
Approval by Dean or Senior Manager
Date
Action taken by Space Management Subcommittee:
Chair, Space Management Subcommittee
Da
te
Chair, Academic Affairs Space Advisory Group
Date
Approved
Not Approved
R
ev. 20200609
Number: 007
Page: 13 of 15
Appendix 8.3.
(page 2)
GUIDELINES FOR SPACE MANAGEMENT SUBCOMMITTEE EVALUATION
OF SPACE CHANGE REPORT
In completing the Space Change Request form on the reverse side, please provide all pertinent
information so that committee members can evaluate how this request will:
1. Facilitate instruction at the program level and affect the overall instructional program of the
University.
2. Improve instructional support.
3. Improve institutional support.
4. Impact on classroom scheduling.
5. Positively affect student, faculty, and staff morale.
6. Improve the image of the University.
7. Facilitate community service.
8. Improve physical accessibility.
In addition, the Committee will review the request to ensure that it:
1. Includes adequate financial planning for implementation as well as on-going costs.
2. Meets Health and Safety Codes.
3. Is compatible with the Academic Master Plan.
4. Is compatible with the Physical Master Plan.
5. Meets Chancellor’s Office guidelines (capacity, utilization, and space use standards).
6. Has endorsement of the Dean or Senior Manager.
Number: 007
Page: 14 of 15
Appendix 8.4.
Guidelines for Completing the Space Change Request form
1. Academic Affairs Space Advisory Group (AASAG) reviews and approves all AA space requests
prior to review by campus Space Management Subcommittee (SMS).
2. Space Request: Provide a brief description of what the job entails.
3. Rationale for Request: Provide an explanation for the basis of the request. For example, indicate
whether the project will improve instructional support, improve institutional support and so
forth. Guidelines to be used by the Subcommittee are attached to the Space Change Request
form and may be used as a guide in completing this section.
4. How Is This Need Currently Being Met: Indicate the function of space as presently assigned.
5. Itemized Budgeted Positions: Indicate all funded positions that will be assigned to the proposed
area space. Also include the source of funding for each position, i.e., grants, general fund, etc.
6. Itemize Renovation Expense: Attach cost estimates from Facilities Services, if appropriate, and
indicate account number of funding source for project.
7. Indicate, if appropriate, whether a specific period of time is a necessity for either beginning
renovation or for occupancy.
8. Approved by ITS (as appropriate): The appropriate ITS administrator must sign all space requests
involving campus telecommunications infrastructure development.
9. Approved by Dean or Senior Manager: All space requests must be signed by the appropriate
Dean/Senior Manager and dated.
10. Action Taken by Space Management Subcommittee: Do not complete.
Number: 007
Page: 15 of 15
Appendix 8.5.
Facilities Services Space Change Request Checklist
Directions: This form is to be completed by Environmental Health and Safety (EHS) and
Facilities Services (FS) and submitted as part of the Space Change Request package submitted
to the Space Management Subcommittee.
Space Change Request Name:
Building:
Floor: Room(s):
NO
NO
NO
1. Electrical Impact:
Explanation:
2. Plumbing Impact:
Explanation:
3. Refrigeration/
HVAC Impact:
YES
Explanation:
4. Space Utilization
YES
NO
Impact:
Explanation:
5. ADA Compliance:
NO
Explanation:
RECOMMENDATIONS:
Reviewed & Completed by:
EH&S Officer
Date Director, Facilities Services Date
YES
YES
YES
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SPACE CHANGE REQUEST Appendix 8.3 Instructions: Refer to (California State University, Los Angeles)

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