State Agency Requesting Access
(Required)
ANF-IT (Administration and Finance - IT)
DCAMM (Division of Capital Asset Management and Maintenance)
DCJIS (Department of Criminal Justice Information System)
DOR (Department of Revenue)
EPS (Executive Office of Public Safety and Security)
EOTSS (Executive Office of Technology Services and Security)
OSD (Operational Services Division)
TRE (Office of the State Treasurer)
Other
Name
(Required)
First
Last
Email
(Required)
Business Phone
Mobile Phone
(Required)
Destination at Facility
(Required)
Who/what group are you visiting at this facility, and what is their location in the facility.
Arrival Date Requested
(Required)
Month
Day
Year
Arrival Time Requested
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Estimated Departure Date Requested
Month
Day
Year
Estimated Departure Time Requested
Hours
:
Minutes
AM
PM
AM/PM
Access Type
Please select one option from the list below that best describes your access request.
Facility Access Request Type
(Required)
Loading Dock Access
Visitor Access
Contractor Work Permit and Access
Other
Loading Dock Access
Company Name
Pickups
Yes
No
Deliveries
Yes
No
Vehicle at Loading Dock
Yes
No
Plate Number
Item(s) Description
Number of Items
If you are a contractor with a DCAMM Work Permit, please provide permit #
Comments
Visitor Access
Visitor(s) Names
Building Escort Name
First
Last
Building Escort Phone
Building Escort Email
Comments
Contractor Work Permit and Access
Contractors are not allowed into DCAMM buildings without a signed copy of this permit. Contractors and agencies must follow all contractor work permit stipulations. Original and copies (as well as related drawings, floor plans, and charts) must be received by DCAMM two weeks prior to beginning the project. All work must be coordinated with the DCAMM Operations office (617) 660-5500.
Agency Head Name and Authorization
Building Location of Work
Area Under Construction (sq. feet)
Project/Scope of work will be managed by
Reason for Work (temp, permanent, phase, etc.)
Desciption of Work
Group E-mail for Project Communication
Anticipated Work Date
Month
Day
Year
Anticipated Work Time
Hours
:
Minutes
AM
PM
AM/PM
Estimated Departure Date
Month
Day
Year
Estimated Departure Time
Hours
:
Minutes
AM
PM
AM/PM
Type of Change
Does work require shutdown or interruption of any building systems. If so, please specify which of the following systems
Fire Alarm
Sprinklers
HVAC System: Air Handlers, Exhaust Fans, Hot Water Steam, Chilled Water
Plumbing: City Water, Hot Water, Drains
Electrical Distribution Panels
Security Systems: Camera or Door Control
Elevators
Escalator
Other
If relocation, please give the Building Room Number(s)
Contractor Information: Main Contractor and all sub-trades
Contractor #1 Name/Company
Contractor #1 Company Phone
Contractor #1 Foreman Name
Contractor #1 Foreman Mobile Phone
Contractor #1 Vehicle Information (Year/Make/Model)
Contractor #1 License Plate Number
Contractor #2 Name/Company
Contractor #2 Company Phone
Contractor #2 Foreman Name
Contractor #2 Foreman Mobile Phone
Contractor #2 Vehicle Information (Year/Make/Model)
Contractor #2 License Plate Number
Contractor #3 Name/Company
Contractor #3 Company Phone
Contractor #3 Foreman Name
Contractor #3 Foreman Mobile Phone
Contractor #3 Vehicle Information (Year/Make/Model)
Contractor #3 License Plate Number
Contractor #4 Name/Company
Contractor #4 Company Phone
Contractor #4 Foreman Name
Contractor #4 Foreman Mobile Phone
Contractor #4 Vehicle Information (Year/Make/Model)
Contractor #4 License Plate Number
Contractor #5 Name/Company
Contractor #5 Company Phone
Contractor #5 Foreman Name
Contractor #5 Foreman Mobile Phone
Contractor #5 Vehicle Information (Year/Make/Model)
Contractor #5 License Plate Number
For DCAMM Use - Engineering
1. Assigned to:
2. Q/A
Sign off from DCAMM Engineering
Approved
For DCAMM Use - Environmental
1. Assigned to:
2. Q/A
Sign off from DCAMM Environmental
Approved
Work Permit Number
Date Returned to Facility Manager
Month
Day
Year
Expiration date
Month
Day
Year
DCAMM Comments
Other
Please provide the type of access you are requesting to this facility.