Facilities Project Request Form Instructions

This form has been created to provide essential preliminary information about the project to enable improved quality and response time. A discovery meeting will be scheduled with you to discuss requirements in more detail. Someone from Facilities Planning might contact you for additional information before the discovery meeting, if this form is incomplete. See Glossary on Page 3 for clarification of key terms used on the form.

Questions? Please call x35045, or e-mail req4fp@umd.umich.edu.

(Note: If your request involves maintenance to or repair of an existing facility or utility [e.g. leaky faucet, too hot / too cold],

please contact Facilities Management at x35270 to initiate a Work Order.)

1. Basic Project Information. Fill in the appropriate fields, including:

a. Name of requestor (Required field.)

b. Project contact name. (Name of the individual to contact for questions or decisions on the project.) (Required field.)

c. Requesting department (Required field.)

d. The campus address of the requestor (Required field.)

e. Requestor’s phone number (Required field.)

f. Requestor’s fax number (Required field.)

g. The building and room number in which the facilities work is required (Required field.)

h. Available project funds (Amount identified and allocated by the department or college for this project request) (Required field.)

i. Requested project completion date (be prepared to discuss rationale for requested date)

2. Brief Project Description (Required field.) Provide a brief description of the project. Provide a sketch of the facility if possible, noting desired changes. Attach catalog page or equipment specifications if applicable. Examples:

a. Purchase and install new furniture in professor’s office.

b. Install overhead fluorescent lighting in laboratory.

c. Install General Atomic gas spectrometry machine (model GSM 0472) in chemistry lab (see catalog page attached). Current model must be removed and disposed.

d. Split classroom in CASL building and create 2 offices for new professors.

3. Project Requirements. This section identifies the specific facilities changes the requestor requires. For each category, check the boxes that apply to the project. Only check categories that are affected by this project. Not all categories apply to all projects. Categories include:

a. Space Requirements (Required field.). This defines if the requested change will occur to the existing space (as noted in Section 1 of this form) or will affect other areas. It clarifies if new space will be created or acquired from another campus unit. It also identifies who owns the targeted space, and whether or not the space has been committed for this project.

b. Building Layout. This section specifies if walls, partitions, doors, ceilings, or floors will require changes. Check the boxes of all items that will require changes.

c. Equipment / Fixtures. Please identify if equipment or fixtures will be affected by this project. You are asked to identify if equipment / fixtures will be installed, removed, or relocated. If equipment / fixtures will be installed, please include a description of the equipment / fixtures, including make and model number in the “Brief Project Description” section (attach a catalog page if possible). If equipment / fixtures will be relocated, please state the current location and the desired location. If equipment / fixtures will be removed, please provide directions for disbursement (dispose, return to vendor, place in storage, put up for sale, etc.). Please refer to Dearborn Administrative Guide, Section 517.12 (DAG-517.12, http://www.fis.umd.umich.edu/ADGUIDE/default.htm).

Note: Fixtures include white boards, attached coat racks, chalk boards, bulletin boards, etc.

d. Furniture. Please indicate if new furniture must be purchased or if existing furniture must be reconfigured, refurbished or disposed of. Also indicate (to the best of your ability) if a design layout is required.

e. Utilities. Please note if you think the facility change will require changes to utilities. Mark which utilities are affected: heating, ventilation, air conditioning (HVAC), electrical, plumbing, telephones, computer connections, audio visual installation or hook-up ability, cable connections, compressed air, gas, etc.

f. Lighting. Please indicate if you think there will be any changes to lighting (fixtures, switches, type, location, etc.). Indicate if any new lighting will be required.

g. Finishes. Please indicate if facility changes will affect / require coverings on floors (carpet, tile, paint, etc), windows (blinds, shades), walls (paint, wall coverings) or ceilings.

h. Signage. Will new signs be required? Will changes be required for existing signs? Please indicate if affected signs are for interior or exterior use. Include exact text required on signs (attach additional sheets if required).

i. Security. Please identify if your project will require new security devices or changes to existing security in the areas of: locks or access control (can include keys, card readers, number code pads, etc.), intrusion detection, theft protection (for equipment, computers, projectors, TV’s, etc.). Please provide an explanation if any other type of security is required.

j. Safety & Environmental. This section is designed to identify if potential safety or environmental issues will exist as a result of this project. Please indicate (to the best of your ability) if changes will

i. Affect research facilities, laboratory facilities, or elevators.

ii. Create or change requirements for hazardous industrial waste handling, chemical / gas / oil storage, air emission sources, cleaning operations, equipment or systems discharging water or wastewater.

iii. Require an eyewash or cause a change to an existing eyewash.

iv. Cause soil erosion or affect sediment.

v. Cause any other type of safety or environmental issue. (Please describe.)

k. Site. These changes generally affect the outside of campus buildings. Please indicate if you think the proposed project will impact campus utilities (such as sewer, water supply, steam pipes, electricity supply, etc.), landscaping, or access to roadways, sidewalks, parking lots or buildings.

4. Funding (Required fields.) Please provide the funding information for the project, including:

a. Account Number	c. Org	e. Program
b. Fund	d. Subclass	f. Project / Grant Number

5. Authorization (Required fields.) Please print the name of the individual with financial authority. This identifies the contact person who will authorize expenditures against this project. Approval from the Authorized Signer will be obtained prior to obtaining outside services. The authorized individual must also sign and date the form prior to submission. Signature here indicates that there is departmental buy-in for the project. The individual named here is responsible for assuring relevant dean/director approvals have been obtained prior to form submission.

6. Note. Project costs include all applicable project-related expenses, including: outside design effort (if required), construction (labor and materials, based on prevailing wage rates), equipment, and fees required to obtain necessary inspections and regulatory certifications (such as reviews by the Office of Fire Safety or code reviews). The project budget will be reviewed with the requestor prior to beginning work. In addition to the project estimate, operational cost impact will be discussed with the requestor.

7. Internal Use Only. Facilities Planning and Facilities Management will track the project internally by assigning a project number and documenting the date the completed project request form is received. The form will also document which department will act as the Lead for the Project.

Other campus groups that could participate in this project are listed here. They will be invited to share information or concerns at a discovery meeting that will be scheduled by the project lead.

If the request is better handled by a Work Order, the project lead will be contacted. That department will be responsible for notifying the requestor and Facilities Planning that the request has been converted to a Work Order. Converting the request to a Work Order will officially close out the Project Request.

8. Submission. Please return the completed Project Request form to the Office of Facilities Planning, 1143 Administration Building, or fax it to: x33830. Please call the Office of Facilities Planning at x35045 if you have any questions in filling out the form.

Glossary

Air Emission Sources	Equipment, cabinets or machines that release, or have the potential to release pollutant / toxic fumes, particulate, or gasses into the air. Can include: chemical fume hoods, biological safety cabinets, laminar flow clean benches, canopy hoods or slot hoods, ventilated workstations, painting or welding booths, incinerators, boilers, turbines, sterilizes, emergency power generators.
Available Funds	Amount identified and allocated by department or college for this project request.
Building Layout (Changes To)	Changes (reconfiguring / removal / addition) to the walls, ceilings, doors, windows, or floors of a building. Could include: full height metal stud gypsum board walls, movable partition walls, furniture systems, half height partitions, access doors, new ceiling layout, acoustical panel ceilings, ceiling modifications, interior architectural woodwork/millwork/finishes, window openings/closings.
Chemical/Gas/Oil Storage	Operations utilizing chemicals, oils, or gas cylinder storage that may include degreasing operations, drum storage, waste oil containers, waste collection area, etc.
Cleaning Operations	Activities involving the use of chemicals and detergents that have the potential to release pollutants into the environment.
Elevator Renovation	Maintenance, improvements, or overhauls to elevators with hydraulic cylinder pistons or oil containing PCBs (polychlorinated biphenyls).
Equipment	Anything other than normal office or classroom contents. Examples include copy machines, fax machines, safes, coffee stations, food service equipment, special purpose items for laboratories, audio visual, etc. Specific catalog information must be provided that defines size, weight, utility requirements, ambient condition requirements, maintenance requirements, health and safety issues. Space and utility connection requirements need to be provided.
Equipment/Systems Discharging Water or Wastewater	Systems discharging wastewater such as: oil interceptors, grease traps, sediment interceptors/sumps, neutralization tanks, photo processing equipment and silver recovery, contact cooling water.
Hazardous/Industrial Waste Handling	Hazard waste - The act or process of producing waste that is corrosive, ignitable, reactive, or toxic. Industrial waste – unwanted materials produced by an operation such as liquid, sludge or solid waste. Examples: radioactive waste; liquids, solids, or sludge waste; some solvent cleaners, stripping products, etc.
Intrusion Detection	The electronic, mechanical or actual observation to detect persons or situations that have defeated security measures to gain access to property, resources, or data of an organization without proper authorization. This would include a person engaged in an illegal or unauthorized act of entering a computer or data system to commit a theft, or intentionally disrupting or vandalizing property belonging to the protected organization.
Lighting	Fixtures, switches, placement, wiring, etc. to achieve desired illumination or control of illumination in a facility. Can address the need to add, relocate, rearrange, replace, or change: fixtures, lenses, lamps, switches, or controls. Can be performed to modify or change lighting or glare problems, or ineffective / inaccessible controls.
Reconfigure	To rearrange the elements or settings.
Refurbish	To make clean, bright or fresh again, renovate.
Relocate	To move to or establish a new place.
Research/Teaching Laboratory Facility	A place equipped for experimental study in a science, or for testing and analysis; providing opportunity for experimentation, observation, or practice in a field of study. Examples: wet bench chemical, radioactive material laboratories, laser laboratory, clean-rooms, machine shops, engine test cells.
Telecom	Connections, hook-ups, or access provisions for: telephones (voice / fax), computers, (network / printers). Can include: relocation or additions of outlets; wired/wireless.
Theft (Security) Protection	Services or measures that address threats or vulnerabilities of an organization to protect an organization form theft or damage to property, assets, or services that would cause disruption or interference with normal operations or business practices.
Utilities	Include: electrical power, heating / ventilation / air conditioning (HVAC), data, telephone, cable TV, water, drainage, natural gas, compressed air, exhaust, etc.