WORK ORDER REQUEST FORM
MAINTENANCE DEPARTMENT
Requester Name:
__________________________
Date: _____________________
Department: _______________________________
Telephone: ________________
Location:
Urgent:
_____________________________________
Yes_____ No_____
Room: ______________
Description of Work Order Requested:
-----------------------Maintenance Use Only--------------------------Description of completed Work Order and Material Used:
Completed By: _____________________________
Date: _____________________________
Time Started: _____________________________
Time Ended: _______________________
The HCCS-Maintenance Department receives and process request work orders daily. Our overall goals are to
schedule and complete these services in a timely manner. In order to perfect our goals, each Campus must
complete a work order form and return to the Maintenance office. Thank you in advance for your cooperation.