BSD Request Form

Thank you for visiting the "Project Intake" form. This form was created in order to provide users with an electronic format to submit their project requests. Your project must be initiated through one of two different paths. Each path has been customized to receive projects of a different type and scale, utilizing a different assemblage of personnel and services.

A) The Plant Work Order Form: This form is located at: http://goo.gl/lAl1Yk and should be used for the following types of minor work requests: installation of shelves; wall and corner guards; other woodwork; picture hanging; assembly of furniture; painting and patching w/ out need for invasive work; specialty plumbing such as acid basins, special lines, and silver recovery traps; refrigeration devices such as freezers, coolers, and ice machines; devices providing dedicated power, UPS, explosion-proof outlets, and UV & germicidal bulbs. Though not comprehensive, this list contains a good sample of projects involving Physical Plant.

B) The Key Work Order Form: For University buildings please contact https://goo.gl/Uv2YRq. For UCM please fill out this form http://goo.gl/mBiA2J along with Authorization from your department leaders https://goo.gl/ADeUCc

C) The Project Intake Form: This form is included below and should be used for all facilities, design, and construction (FDC) related requests: 1) a space planner; 2) project planner; 3) architect/engineer; and 4) cost estimator. This form should be used for any requests that require invasive work involving electrical, plumbing, heating, cooling, or coordination with CBIS /IT. The majority of all requests typically utilize this form. The following resources are provided to assist in your submission: Office Space Guidelines; Furniture Budget Calculator, and are located at here.

D) The UCH Project Intake Form: https://app.smartsheet.com/b/form/934f3fbe87924811a1e9709d755b4891

Project Type: Please select... Ambient Upgrade Code Compliance/Corrections Estimate Only Equipment Furniture Infrastructure Upgrade Landscape/Hardscape New Construction Renovation Relocation Professional Services Signage and Wayfinding Space Request

- Choose organization
Please select... BSD/PSOM UCH

- Do you require additional Work? such as setup jack, power, carpet, lighting, patch, and/or paint?
Please select... Yes No

- Project Cost
Please select... Less than eqal to $100,000 Greater than $100,000

Full Name: Email: (separated by semicolon) Funding Source: Please select... BSD BSD - DEPT SPLIT BSD/DEPT UNIV Department: Please select... AAA ARC BENMAY BMB BSDHR BSDISO CANCER CBIS CDIS CLINICAL CRI CTSA DACC DEAN DEVELOP DOM EE FAMILY FDC HEALTH HG IBD IGSB MARKET MGCB MICRO NB NEURO NORTH NPP NSI OBA OBGYN OCR OPHTH ORTHO OTHER PATH PEDS PRITZ PSYCH RAD RADONC SIM SRF SURG UCPG Department Name: Funding Source Account #: Available Budget: VP/Chair/Appointee Approved?: Please select... Yes No VP/Chair/Appointee Name: Project Name: Reason for Project: Building: Please select... TBD A10 Rubloff Intensive Care A11 Kovler A14 Surgery Brain A15 Abbott A16 Peck Pavilion A17 Wyler Pavilion A18 Armour A19 Franklin McLean Research Institute A20 Goldblatt A21 Hicks McElwee A22 Carlson A23 Billings A24 Bobs Roberts A25 Gilman Smith A26 Goldblatt Pavilion A27 Chicago Lying-In A50 MRS Facility (CLSC) A62 Cummings A70 Medical Campus Parking A A71 Mitchell Hospital A72 MRI A73 Parking/Material Mgmt A75 Duchossois Center A84 American School A86 Gordon Center for Integrative Science A87 Comer Children's Hospital A94 Comer Center for Children A95 Center for Care and Discovery B36 Donnelley BSLC B49 Greenhouse B52 Knapp Research Center B98 Knapp Center for Biomedical Discovery B126 Medical Campus Parking B D05 Zoology D06 Anatomy D10 Culver D11 Erman Biology Center I28 61st & Drexel Parking Structure L11 Friend's Center B03 Accelerator Building E52 McGiffert House I13 Woodlawn Social Service Center K09 UCPG Physical Therapy (Therapy Services) X06 Darien Hospital Finance (UCMC Finance) X68 Matteson Building (Surgery-Sports Medicine) X69 Stony Island Dialysis Center (Dialysis) X70 Southshore Senior Center (DOM-Geriatrics Clinic) X71 Darien Data Center (CBIS-Data Center) X76 230 West Monroe (DoM-CALGB) X78 IVF Lab/Clinic (OBGYN Clinic) X79 Estancia Corporate Center (UCPG Administration) X81 Prudential (Development) X85 Ingalls Family Care Center (Pediatrics Clinic) X86 Commodore Professional Building (Pediatrics Clinic) X88 Huron (DOM/ Cardiology) X92 Naperville Professional Office Building (Pediatrics Clinic) X93 Silver Cross (Oncology) X94 Silver Cross MOB (OBGYN Clinic) X105 Cedar Center MOB X106 Alliance MOB X107 Bridgeport MOB X108 Elgin MOB X109 Elgin MOB (Sherman Hospital) X110 Streeterville MOB X111 ASTC Surgicenter X112 Orland Park Center for Advanced Care Z43 Medbourne Place (Pediatrics Clinic) Z45 Plum Creek Center (OBGYN Clinic) Z46 St. Mary's Medical Center (Psychiatry) Room number: Description / Project Requirements: Schedule drivers or milestones: Related Moves: Regulatory Compliance Needs:

Note: Send Attachments to S. DeBlaze (Layouts, Staffing Plan, Org Chart, Equipment List, etc.)

If you have additional questions please contact:

• Scott DeBlaze, Executive Director of Space Planning, Real Estate Management, and Architectural Services (sdeblaze@bsd.uchicago.edu) - 773-702-1658

For technical difficulties please contact:

• Masahiro Kinoshita, Space Information and Technology Manager (mkinoshi@bsd.uchicago.edu) - 773-704-3418