WORK AUTHORIZATION

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

WORK AUTHORIZATION

• I am requesting A&R Services to perform work that is not included in the scope of work in their contract. My firm is responsible for their payment and I will verify labor time via signed tickets that will be entered into the contract in the form of a change order.

  Yes

  No

  N/A

• Select date

  Date

• Name:

• Add signature

  Sign