MAINTENANCE WORK ORDER
FROM:____________________________________________ DIVISION/DEPT.:______________________________________
Person Requesting Work
CAMPUS: ____________________________ LOCATION OF WORK:_______________________________________________
Building and Room Number
CONTACT PERSON:______________________________________ PHONE NUMBER: _______________________________
DESCRIPTION OF WORK REQUESTED:
APPROVED:
_____________________________________________ ___________
Associate Dean/Director/Department Head Date
_____________________________________________ ____________
Campus Provost/Dean or Vice Chancellor (as appropriate) Date
_____________________________________________ ____________
Director, Facilities Planning Date
MAINTENANCE DEPARTMENT USE ONLY
DATE ASSIGNED:____________________________ TOTAL MAN HOURS:_______________________
DATE COMPLETED:__________________________
WORK CREW:_________________________________________________________________________________________________
SUPPLIES USED:______________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ COMMENTS:____________________________________________________________________________________________________ _____________________________________________________________________________________________________________ |
Form No. 1330/001 (Rev. 4/03)