IBEW Local 77 Dispatch Request Form - Seattle

Employer Name:
Date:
Time:
Point of Contact:
Cell Phone #:
Email Address for Referrals:
Office Phone #:
Worksite Location:
Report to Location:
Workers Needed:
Foreman:
Foreman by Name:
Tree Trimmer Foreman:
Lineman:
Tree Trimmer:
Line Equipment Man:
URD Operator:
Tree Groundman:
Groundman:
Meter Installer:
Other:
Certifications Required:
Job Details:
Start Date:
Start Time:
Shift (4-10's, 5-8's, 5-10's or 6-10's) - REQUIRED:
Other Shift; Explain:
Job Duration:
End Date:
Crew Foreman:
Job Description:
Requirements:	First Aid/CPR
	CDL     Flagging Card
Crane Certification and Type:
Drug Testing:
Puget Property:
Other Requirements; Explain:
Transmission:	Wood PoleSubstation
Distribution:	UndergroundOverheadMeter InstallerSubstation
Agreement:	NECAUnderground LOATree Trimming
Other Agreement; Explain:
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For IBEW LU 77 Office Use Only:
Name:
Hall:
Email:
Mail:
Done?:
Classification:
Today's Date: