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>
Division of Facilities Services
>
Leasing
> Office Status Questionnaire
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Office Status Questionnaire
PLEASE FILL OUT THE FOLLOWING FORM IF THERE IS A WEATHER OR MECHANICAL SITUATION AT YOUR WORKPLACE, AND SUBMIT IT TO THE DEPARTMENT OF TRANSPORTATION & PUBLIC FACILITIES
QUESTIONS?
rob.daly@alaska.gov
,
907-269-0300
Name:
*
Title:
*
Email:
*
Best Phone to Reach You:
Department:
*
Select...
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Division:
*
Supervisor's Name:
*
Supervisor's Email:
*
Your Department Administrative Services Director (ASD)
*
ASD Director's Email:
*
Building name, address, city, and lease number (if known):
*
Please describe the current situation at your workplace:
*
What other SOA Departments are in your building? (n/a if none) Approx. how many employees?:
*
Do you have access to running water?:
*
YES
NO
Is the plumbing working?:
*
YES
NO
Is the electricity on?:
*
YES
NO
Is the heat working in your building (if necessary)?:
*
YES
NO
Is weather preventing you from getting to your workplace?:
*
YES
NO
Do you feel that there is work you are able to do without electricity (i.e. phone calls, filing, cleanup, meetings, etc.)?:
*
YES
Are there any other hazards we should be aware of?:
*
NO
Are you asking to:
*
Leave early
Begin the day later
Keep the office closed for the workday
None of the above
Submit Questionnaire to DOT&PF
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