SECTION I - SECTION II - SECTION III - SECTION IV - SECTION V (APPENDICES)
V.Cover | V.A | V.B | V.C | V.D | V.E | V.F | V.G | V.H | V.I | V.J | V.K | V.L | V.M | V.N | V.O | V.P | V.Q

Appendix O

WORK PERMIT FOR MAINTENANCE / CONSTRUCTION
ACTIVITIES IN LABORATORIES

This section to be completed by Facilities Operations to perform work
in the following Authorized Work Zone

Building:	Dept:				Room No:	Work Start Date:	Work Finish Date:
Project Title:							FacilityFocus No.
Specific work to be performed:
Systems or space adjacent to the Authorized Work Zone that will be affected by the work:
Work will be performed by     FacOps    Contractor   Both
Dept Contact:				Email:		Phone:	Fax:
FacOps Contact:				Email:		Phone:	Fax:

Must be completed by the Principal Investigator (PI) or Designee
before Maintenance/construction activities are performed.

Lab PI:	Email:	Phone:	Fax:
Lab Designee or Contact:	Email:	Phone:	Fax:
Dates Research work will be suspended in Authorized Work Zone:		From:	To:
No hazards ever were or are present.
All hazards were decontaminated and cleaned.
All surfaces and equipment in the Authorized Work Zone have been decontaminated and cleaned. It is safe to carry out activities.
All hazards were decontaminated and cleaned except for:
Biological Describe:
Chemical Describe:
Radioactive Describe:

Recommended Precautions for WSU Facility Operations Personnel.

Describe (i.e. Personal Protection etc):

Measures to protect research:

Acknowledgements

Work Permit Completed / Access approved by Lab PI / Designee	Name:	Signature:	Date:
Work Permit Completed/Approved by Facilities Operations	Name:	Signature:	Date:

The Lab Safety Work Permit must remain posted at the Authorized Work Zone while
construction work is in progress.

Note: Research activities must be suspended in Authorized Work Zone. The Lab PI/Designee must notify
Facilities Operations if research activity is resumed and reinitiate this Work Permit process
before work continues.

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