EOANF-DCP

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)

Arrival Time Requested(Required)

Estimated Departure Date Requested

Estimated Departure Time Requested

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

Deliveries

Yes

Vehicle at Loading Dock

Yes

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

Anticipated Work Time

Estimated Departure Date

Estimated Departure Time

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

For DCAMM Use - Environmental

1. Assigned to:

2. Q/A

Work Permit Number

Date Returned to Facility Manager

Expiration date

DCAMM Comments

Other

Please provide the type of access you are requesting to this facility.