Date: _____________
Missouri State University
Utility Interruption Sheet
Date of Outage: _______________________
Start Time: ________________________
End Time: ________________________
Requester Fill Out Lower Section Only
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Effected Buildings: ______________________________________________________
Contact Person: _______________________________________________________
Reason for Outage: _______________________________________________________
Utility Type/Types: _______________________________________________________________
Number of Hours Needed: _________________________________________________
Services Effected: ________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Preferred Date & Time: ____________________________________________________
Start Time: ______________________________________________________
Please fill out above and fax this form to the Work Management Center @ 65288
Please give us a two week notice.
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Date: __________ Approved Disapproved |