Institute of Polymer Engineering Work Request
Date:
Advisor:
Building:
Requestor:
Email:
Lab Room
NPIC or Olson
This is to request ALL work from Institute Staff including equipment repair, modifications and fabrication of
new equipment. For fabrication (machine shop use) the request must include a detailed drawing (with
dimensions) and any specific materials that are to be used. All work requests are reviewed for completeness
and for safety prior to any work being done. Any safety issues found must be addressed prior to any work being
done. Advisor’s signature and account code is REQUIRED unless the equipment is Institute owned.
Description of Work Requested
(include detailed drawings for any items that need to be fabricated)
Request Reviewed and Approved: ______________________________________________________________
Materials Purchased:
Hours Charged:
Date Completed:
*If not Institute repair, please have Advisor assign an account & sign*
Account code
Advisor’s signature