Maintenance Request Form printable pdf download

FORM 114

MAINTENANCE REQUEST FORM

Date:____/____/____

Requested by: ____________________________________________________

Building or site:

Room or location:

Work Requested: _______________________________________________________________________

______________________________________________________________________________________

*Attach a Diagram if Necessary

Authorisation - to be completed by Manager:

□

Is this a WHS issue?

Yes

Not Sure

Expenditure Limit: $ ________________

□

Urgency of job:

Normal

Fairly Urgent

Very Urgent

Manager’s Name:________________________________ Signature: ______________________________

Receipt - to be completed by Maintenance Supervisor:

Date request received: ____/____/____

MAINTENANCE REQUEST COMPLETION FORM

To be completed by Maintenance Supervisor:

Date: ____/____/____ Register No: _______________________

Job: ________________________________________________________________________________

Action taken: __________________________________________________________________________

______________________________________________________________________________________

□

Action completed?

YES

Follow up required or comments:

______________________________________________________________________________________

Signed: __________________________________________________Sent to Manager: ____/ ____/ ____

Kurrajong Waratah Policies and Procedures Manual

last reviewed 21 November 14

authorised by DCEO

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Maintenance Request Form