Robot Operation Permission Request Form
Request approval to operate a robot by providing all required details below.
Full Name of Requester
*
First Name
Last Name
Email Address of Requester
*
example@example.com
Organization or Department
*
Robot Identification Number or Name
*
Robot Type / Model
*
Please Select
Industrial Arm
Mobile Platform
Collaborative Robot (Cobot)
Autonomous Drone
Service Robot
Other
Intended Operation Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Operation Location
*
Purpose of Operation
*
Expected Duration (in hours)
*
Have all required safety checks been completed?
*
Yes, all safety checks completed
No, pending safety checks
Required Supervision or Approver Name
*
Contact Email of Supervisor/Approver
example@example.com
Additional Notes or Comments
Submit Request
Should be Empty: