Authorization to Operate Request
Submit this form to request official authorization to operate specified equipment, machinery, vehicles, or facilities.
Applicant Full Name
*
First Name
Last Name
Applicant Email Address
*
example@example.com
Applicant Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Department or Organization
*
Equipment, Vehicle, or Facility to be Operated
*
Please Select
Forklift
Company Vehicle
Laboratory Equipment
Heavy Machinery
IT System/Server
Other
Please specify the make, model, or unique ID (if applicable)
Location of Operation
*
Intended Start Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Intended End Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Purpose of Operation
*
Supervisor or Authorizing Official Name
*
First Name
Last Name
Supervisor/Authorizer Email Address
*
example@example.com
Applicant Signature (required for authorization)
*
Submit Request
Submit Request
Should be Empty: