Form

Purchase (or Purchases) of Services Justification Form

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A form used to classify services being requested by a department.

A form used to classify services being requested by a department.

Download Purchase (or Purchases) of Services Justification Form

If there are any Intellectual Property Ownership issues associated with an agreement or contract, complete the Intellectual Property Rights Sole Source Form (Schedule A) and return to purchasing services.

Related materials, policies, and procedures

Near Miss – Unsafe Act – Unsafe Condition Report

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UW-MADISON NEAR MISS / UNSAFE ACT / UNSAFE CONDITION REPORT

Download Near Miss Report 1018

Near Miss (sometimes described as near hit) describes incidents where no property was damaged and no personal injury sustained, but where, given a slight shift in time or position, damage and/or injury easily could have occurred. This report is intended to help document these situations with the goal of prevention of future similar events. This form can also be used to report general unsafe acts and/or conditions. Anyone of the campus community may complete and submit. It is everyone’s responsibility to report and/or correct these potential accidents/incidents immediately.

The completed report is to be given to one’s supervisor/chair/faculty/building manager or other responsible individual for review and action. If necessary immediate corrective action shall occur to either eliminate the hazard or implement temporarily solutions until long term resolution is completed. This may include writing a work order to Facility Services for repairs. Attach pictures, additional sheets, and other documentation if available.

Contact Supervisor for assistance in evaluation of these events. Supervisor may contact Environment, Health and Safety for evaluation assistance as necessary at (608) 265-5000.

Item Type Request Form

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An Item Type is used when posting departmental payments to student tuition accounts. It defines the various attributes of the payment in the Student Information System (SIS) and creates the link between the payment and your GL funding. Item Type is a required field on the upload file. It’s very important that the correct item type is used when submitting your requests.

Use this form when posting departmental payments to student tuition accounts.

This form defines the various attributes of the payment in the Student Information System (SIS) and creates the link between the payment and your GL funding. Item Type is a required field on the upload file. It’s very important the correct item type is used when submitting your requests.

Download Item Type Request Form (Excel)

Custodian Fund Request Form

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This form is used to request custodian funds for Human Subjects Studies, Change Fund and Petty Cash.

A form used to request custodian funds for Human Subjects Studies, Change Fund, and Petty Cash.

Custodian Fund Request Form (PDF)

How to complete the Custodian Fund Request Form

  1. Provide details about the requested fund. Based on your budget form, enter a positive amount for the total of the request. Enter the Workday FDM values you want these expenditures to be charged to.
  2. Enter unique 7-digit Custodian Fund ID from original Custodian Fund Request Form. All custodian funds will start with NR, followed by the unique 7-digit Custodian Fund ID.
  3. Put an “X” in the “Type of Custodian Fund Request” section (i.e. Research Participant Study, Petty Cash, Change Fund, or Reloadable Debit Cards – Research Participant Study).
  4. Ensure that the IRB number is entered into the “IRB Approval No” box.
  5. Fill in the Start Date and End Date of the study under the “Time Period” section.
    • For Temporary Request mark “X” 3 months or less.
    • For Reloadable Debit Card Account mark “X” 1 year or greater.
  6. Fill in the custodian name and check payable information. Check payable will most likely be the custodian of the study. Fill in the building name, address, city, and state underneath the custodian name and check payable lines.
  7. Leave the “If address is different[…]” boxes empty unless the check’s intended delegate or address is different than the custodian address.
  8. Complete the “For additional information call” section with the contact name and phone number.
  9. Under the “Description/Amount Requested” section, provide a description of how the advance will be used. Fill in the Research Participant Study title, IRB Approval No., IRB Begin Date, IRB End Date, and provide a description of the project. If the operation is a Petty Cash Fund, provide a description of the operation under the respective section. If the operation is a Change Fund, provide a description of the operation under the respective section. Include the amount of requested advance for each operation needed.
  10. Confirm/enter the total amount of advance(s) from all requested operations in the “Total Amount Requested” section.
  11. Form is signed by the custodian. A delegate signature is also required if the check is not payable to the custodian.

Department/Unit

  1. Verify information on Steps 1-11.
  2. Department approver signs custodian fund accounting form.
  3. File original documents in department.
  4. Send copy(s) to the Dean’s/Division Office for approval.

Custodian/Department

Keep a copy of the Custodian Fund Agreement along with the Custodian Fund Request Form and Custodian Fund Budget Form for internal records.

Dean/Director’s Office

Keep a copy of Custodian Fund Agreement Form along with the Custodian Fund Request Form for internal records. Send original documents to Cash Management, 21 N. Park Street, Suite 5301.

Policy & Procedure

UW Policy 3012 – Custodian Fund Policy

Contact

Questions about this form can be sent to cstdnfnd@bussvc.wisc.edu.

Custodian Fund Agreement Form

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Use this form to request custodian funds for human subject studies, change funds, petty cash and contingent bank accounts. All Custodian Agreement must be completed by the Custodian and approved by the Department and Dean's Office before the advance is sent onto Cash Management for processing. All agreements must have a Custodian Fund Request Form and Custodian Fund Budget Information Form attached with this agreement.

Use this form to request custodian funds for human subject studies, change funds, petty cash, and contingent bank account.

Download the Custodian Fund Agreement Form (PDF)

Instructions

Custodian Funds are advanced only to authorized, permanent UW–Madison employees. The Custodian Funds are issued for a specific purpose and may not be used for any other purpose than expressed on the Custodian Fund Request Form.

All Custodian Funds must be reconciled monthly to authorized advance levels and properly accounted for within 30 days of the end of the advance period.

All Custodian Funds require, quarterly reporting, regardless of activity, to ensure advance levees are maintained by using the Custodian Fund Accounting Form.

Top paragraph: Fill in the dollar amount of the Custodian Fund and enter the same amount in the Custodian Fund Request Form. Enter begin and end dates of the Custodian Fund Request. Enter the Custodian Fund reference number which agrees with the Custodian Fund Request Form.

Individual Custodian Agreement paragraph: Enter the custodian name and ensure it agrees with the Custodian Fund Request Form. Include in this section, the Custodian telephone number, and the Custodian e-mail. The Custodian must sign and date this Custodian Fund Agreement before it can be reviewed for approval and processed.

Department Agreement paragraph: Filled in the Department name.

Bottom section of this agreement:

  • Print Name (Department Representative): Filled in with the name of the department representative.
  • Telephone Number (Department Representative): Fill in with the telephone number of the department representative.
  • Email (Department Representative): Fill in with the email address of the department representative.
  • Signed (Department Representative): This section must be signed and dated by the department representative.
  • Signed (Dean/Director): This section must be signed and dated by the Dean/Director.

Custodian/Department

Keep a copy of the Custodian Fund Agreement along with the Custodian Fund Request Form and Custodian Fund Budget Form for internal records.

Dean/Director’s Office

Keep a copy of the Custodian Fund Agreement along with the Custodian Fund Request Form and Custodian Fund Budget Form for internal records. Email documents to cstdnfnd@bussvc.wisc.edu or send to Cash Management, 21 N. Park St., Suite 5301, Madison, WI 53715.

Related policies and procedures

UW-3012 Custodian Funds Policy

Contact

Questions can be directed to cstdnfnd@bussvc.wisc.edu.