Continuous Running Notice

Responsible Person:

Room:	Contact Number:

Brief Description:

Emergency Action:

Details and location of Services:

Request From: Click here to enter a date.	Request: To: Click here to enter a date.

Permanent: ☐ (Tick if appropriate)	Note: For equipment that is to be left running for	more than 1 year, 'Permanent' should be selected.

Print out form once completed and obtain signature of Facility Manager prior to affixing copies on the entrance door and next to the equipment that is running.

Approved By:	Signature of Facility Manager

Upon completion of the work and expiry of the continuous running period, this Notice must be closed out by return of the Continuous Running Notice to the Facility Manager.

Approval Expired:	Signature of Facility Manager