Permitted Equipment Operators Request

What Type of Request?
Contact Information
Operators Name(Required)
Drivers License
Identify specific type of equipment and location of operation

Type (check all that apply)
Powered Industrial Vehicles
Aerial Lifts
Mobile Equipment
Tractor
Cranes
UM Employee Requests
CVL Requests
Max. file size: 300 MB.
Max. file size: 300 MB.
Evaluator/Supervisor Signature(Required)
I certify that the operator listed above has demonstrated safe operation of the indicated equipment.

Michigan Block M

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