template
Maintenance request intake form
Capture the facts needed to triage and assign a repair.
MAINTENANCE REQUEST
Property / unit:
Reported by:
Safe contact method:
Reported date and time:
Fault description:
When first noticed:
Affected area or equipment:
Safety concern:
Photo references:
Access arrangements:
Staff triage
Priority:
Immediate safety action:
Assigned contractor:
Approved scope / budget:
Target attendance:
Owner approval reference, if required:
Completion
Attendance date/time:
Work performed:
Parts / costs:
Completion date/time:
Evidence references:
Follow-up:
Reviewed by:
This form is not an emergency response service. Escalate immediate hazards using your local procedures. Collect only the information necessary for the repair.