| 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: | |||||||
| _____________________________________________ | ___________ | |||||||||
| Director/Department Head | Date | |||||||||
| _____________________________________________ | ____________ | |||||||||
| Campus Executive Dean/Division Dean/ 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. 6/12) | |||||||||||||