Work Order

Today's Date (i.e. 06/02/2016):*
MM slash DD slash YYYY
Department Name:*
OrgID Number:*
Contact First Name:*
Contact Last Name:*
Contact Phone:*
Contact Email:*
Campus Building:*
Room:
Description of Property to be turned in:*
Retirement / Transfer (RT) Complete?
- Yes
- No
Retirement / Transfer (RT) Number:*

Please enter RT Number
Special Instructions:
Any High Value Equipment (current value greater than $1000)?
- Yes
- No
If yes please describe in notes box below.
High Value Notes:
Does the equipment work?
- Yes
- No
If no, please comment on the condition of equipment in the notes box below.
Notes on condition of equipment:
Does the equipment contain or is it made up of any hazardous material, freon, oils, etc.?
- Yes
- No
If yes, contact EHS or follow the instructions "Refrigeration Equipment and Appliance Disposal" and do not submit this form.