Simple Works Request Form Please consider the following prior to lodging request:

1. Is the value of the work estimated to be less than the threshold set by your agency Yes No

2. Is the work free of hazardous materials like asbestos? Yes No

3. Does the work exclude structural or layout changes requiring a building permit? Yes No

4. Is the work free of overload or adverse effect on services, such as electrical, water,drainage and sewer? Yes No

5. Are you confident there will be adequate oversight of the work? Yes No

6. Do you have the funds to pay for this work? Yes No

If the answer is NO to any of the questions or if you are unsure you must contact either BMW or your agency’s facilities/asset management team for assistance. Otherwise, please complete the remainder of this form and email to the Maintenance Services Centre at bmwsimpleworks@royallifesavingwa.com.au

Section 1: Authorised Requestor Details (all fields are mandatory)The person authorised to approve funding for requested work.

Full Name: Date:

Title: Tel:

Email:

Client Order Number or Job Registration details:

Funding Source Head office funded Site funded

Section 2: Site Details (all fields are mandatory)

Site Name: Site ID Number:

Site Address:

Section 3: Works Authorisation (all fields are mandatory)The person nominated below is responsible for arranging site access, finalising the scope of work, authorising the contractor to proceed and

signing off on the works once complete.

Section 4: Works Details

Section 5: To be completed by the Maintenance Services Centre

Job Number:

Supplier Name: Supplier No: Agent ID:

Processing Date/Time: Trade Code:

Version 4 (23 February 2018)

Name: Tel:

Email: