Accurate location information is critical for rapid response. Please provide precise details to help our facilities team locate and address the issue efficiently. All fields marked as mandatory must be completed to prevent delays.
Full Name
Employee ID Number
Department or Business Unit
Information Technology
Human Resources
Finance & Accounting
Marketing & Communications
Operations
Legal & Compliance
Executive Management
Facilities Management
Other
Please specify your department
Email Address
Phone Extension or Mobile Number
Building Name or Number
Floor Level
Basement Level 3
Basement Level 2
Basement Level 1
Ground Floor
Floor 1
Floor 2
Floor 3
Floor 4
Floor 5
Floor 6
Floor 7
Floor 8
Floor 9
Floor 10
Floor 11-20
Floor 21-30
Floor 31+
Please specify exact floor number
Please specify exact floor number
Please specify exact floor number
Zone or Section Code
Room Number or Office Identifier
Exact Location Details and Landmarks
Is this a recurring issue that has happened before?
How many times has this occurred in the past 30 days?
When did you first notice this particular issue?
Have you previously submitted a maintenance request for this same location or equipment?
Previous Request Reference Number
Proper categorization helps route your request to the right specialist immediately. The severity rating enables priority triage to ensure critical issues receive emergency response. Please be objective and accurate in your assessment.
Primary Issue Category
Heating, Ventilation & Air Conditioning (HVAC)
Plumbing & Water Systems
Electrical & Power Systems
Door Access & Security Systems
Safety & Emergency Systems
Structural & Interior Fixtures
Other Issue Type
HVAC Sub-Category
No heating or cooling
Insufficient heating/cooling
Strange noises or vibrations
Unusual odors (burning, gas, musty)
Temperature control unresponsive
Poor air flow or ventilation
Water leaks from unit
Thermostat malfunction
Filter or duct issue
Plumbing Sub-Category
Water leak (pipe, fixture, or appliance)
Drain blockage or slow drainage
No water supply
Low water pressure
Water discoloration or quality issue
Toilet malfunction
Fixture damage (sink, faucet, etc.)
Unusual water sounds
Sewage or backflow issue
Electrical Sub-Category
Complete power outage
Partial power loss (specific outlets)
Flickering lights
Circuit breaker tripped repeatedly
Power socket not working
Equipment sparking or burning smell
Light switch malfunction
UPS or generator issue
Electrical panel concern
Door Access Sub-Category
Card reader not responding
Door will not lock securely
Door will not unlock/open
Door stuck or jammed
Broken handle, hinge, or closer
Forced entry or security breach concern
Access control system offline
Key or cylinder issue
Automatic door malfunction
Safety Sub-Category
Fire hazard (non-immediate)
Trip, slip, or fall hazard
Chemical spill or exposure risk
Broken glass or sharp edges
Emergency exit blocked or inaccessible
Fire extinguisher missing or damaged
First aid kit issue
Lighting emergency failure
Structural instability concern
Structural Sub-Category
Ceiling tile damage or water stains
Floor tile or carpet damage
Wall damage (holes, cracks, moisture)
Window or glass issue
Furniture or fixture damage
Noise insulation problem
Paint or finish deterioration
Pest sighting or concern
Please describe the issue type in detail
When was the issue first noticed?
Is the issue actively ongoing right now?
Severity Rating - Rate the operational impact level
Severity Rating Guide: 1 = Minor inconvenience (aesthetic, minimal disruption), 2 = Moderate disruption (affects comfort but work continues), 3 = Significant impact (notable productivity loss, multiple users affected), 4 = Major disruption (area unusable, critical systems compromised), 5 = Critical emergency (immediate safety risk, life safety systems failed, business continuity threatened)
Impact Assessment - Select all areas affected
Employee health and safety
Property or asset damage risk
Direct productivity loss
Client or customer service impact
Regulatory compliance concern
Data center or IT equipment
Meeting or event disruption
No significant impact beyond location
Estimated number of employees directly affected by this issue
Does this issue affect business-critical operations or systems?
Describe which critical business systems, processes, or departments are impacted
Can normal work activities continue safely in this area?
Yes, work can continue with minor adjustments
Yes, but with significant inconvenience
No, area should be evacuated or closed
No, immediate shutdown required
What alternative workspace arrangements are needed for affected staff?
What alternative workspace arrangements are needed for affected staff?
Detailed descriptions and visual evidence significantly accelerate diagnosis and repair. Please be thorough in your explanation and upload multiple photos from different angles. Include any error messages, unusual sounds, odors, or behavioral patterns of the affected system.
Comprehensive Problem Description
Error Codes or Diagnostic Messages
Equipment or Asset Tag Number
Have you attempted any troubleshooting or corrective actions?
Describe exactly what troubleshooting steps you performed
Did your actions improve, worsen, or have no effect on the issue?
Significantly improved
Slightly improved
No change
Slightly worsened
Significantly worsened
Is there visible damage to equipment, fixtures, or the building structure?
Can you estimate the approximate cost of damage or required replacement?
Upload Photographs of the Issue - Minimum 2 photos recommended
Upload Additional Photos from Different Angles or Context
Upload Supporting Documents - Equipment manuals, previous service reports, warranty information, or relevant correspondence
Does this present an immediate safety hazard to people in the vicinity?
Immediate Danger Level - Rate the risk of injury in the next 24 hours
Has the affected area been secured, barricaded, or marked with warning signs?
Please describe what safety measures should be implemented immediately
Additional Comments or Special Instructions
To ensure efficient repair work, we need to coordinate access timing and security requirements. Please specify when maintenance personnel can access the location and who will be available to grant entry. This information helps avoid delays and ensures compliance with security protocols.
Preferred Access Date
Preferred Access Time
Are there specific time restrictions or blackout periods?
Business hours only (8:00-18:00)
After hours permitted (18:00-22:00)
Weekend access OK
No time restrictions
Other specific restrictions
Who can grant physical access to the affected area?
Myself - I will meet the technician
Facilities Manager
Department Head
Security Operations Center
Reception Desk
Other designated person
Facilities Manager Name
Department Head Name
Security Contact Name
Reception Contact Name
Designated Contact Person Name
Is a physical key or access card required to enter the area?
Where can the key or access card be collected? Provide exact location and any collection procedures
Are there security clearance or escort requirements for external vendors?
Describe the security clearance level required and escort procedures
Will someone be present at the location during the repair work?
Who should the technician contact upon arrival? Provide name and phone number
Special Access Instructions
Are there parking arrangements available for vendor vehicles?
Where should vendors park? Provide location and any permit requirements
Does the repair require equipment shutdown or power isolation?
Who can authorize equipment shutdown or power isolation?
Can the work area be left unlocked if no one is present?
This section is for Facilities Management team use to authorize work, assign vendors, and document dispatch decisions. Proper authorization ensures compliance, budget control, and quality assurance. All critical maintenance requires manager sign-off before external vendor dispatch.
Does this repair require external vendor support beyond internal facilities capabilities?
Preferred Vendor Company Name (if applicable)
Estimated Budget Approval Required
Internal Facilities Team Assessment Notes
Priority Assignment for Dispatch
Emergency - 2 Hour Response Required
Critical - Same Day Response
High - 24 Hour Response
Medium - 3 Business Day Response
Low - 5 Business Day Response
Scheduled Maintenance - Next Available Slot
Assign To
Internal Facilities Maintenance Team
External Vendor - HVAC Specialist
External Vendor - Licensed Plumber
External Vendor - Certified Electrician
External Vendor - General Contractor
External Vendor - Security Systems Technician
External Vendor - Fire Safety Systems
External Vendor - Other Trade
HVAC Vendor Contact
Plumbing Vendor Contact
Electrical Vendor Contact
General Contractor Contact
Security Vendor Contact
Fire Safety Vendor Contact
Specify Trade and Vendor Contact
Facilities Manager Approval Signature
Vendor Dispatch Date and Time
Expected Completion Date
Approved Cost Estimate
Purchase Order Number
Vendor Primary Contact Details
Is a formal safety briefing or site induction required for external vendors?
Safety Briefing Notes and Site-Specific Hazards
I authorize the work to proceed based on the information provided, confirm budget availability, and accept responsibility for dispatch coordination
To configure an element, select it on the form.