Chilled Water System Shutdown Request Form
(University Campus Engineering)
Requestor Name
Department / Unit
Contact Number
Email Address
Building(s) / Area(s) Affected
Requested Shutdown Date
Start Time
Estimated Restore Time
Reason for Shutdown
Precautionary Actions / Special Requirements
Date Submitted
Signature of Requestor
For Engineering Office Use Only:
Engineer Approval / Comments
Engineer Name
Date