Permit Request • CampusOptics

Submit this form to CapU Safety in advance of the first planned workday

This form is initiated by the employee or contractor requesting the service shut down
This request will be reviewed and verified by CapU Safety prior to authorization
Upon approval, CapU Safety will authorize the request and the CapU Liaison will inform the requesting employee or contractor
All contractors must attend a site orientation prior to starting work and annually thereafter
Contractors will sign in and out with security each day that they are on campus
Attach copies of hazard/risk assessments, safe work procedures, training certificates and other safety documents below.

PLEASE CONTACT YOUR CAPU LIAISON FOR ADDITIONAL INFORMATION

Requester Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Start Date* Required

Start Time* Required

Expiration Date* Required

Expiration Time* Required

Name* Required

Additional Location Details

Project Name* Required

CapU Liason* Required

CapU Liaison Cell* Required

Contractor Name* Required

Site Supervisor* Required

Site Supervisor Cell* Required

Type of Service* Required

Building/area impacted* Required

Impacts - select all that apply* Required

Impacts - other* Required

Scope of Work - system components and area being affected* Required

Add files to upload as supporting documentation along with your permit request.

Files