Maintenance Request Form

Purpose: This form is used to report any malfunctioning equipment or request maintenance for operational tools, machinery, or infrastructure. It helps ensure timely repairs and maintain facility safety and efficiency.

Requester Information

Name: {requesterName}

Department: {department}

Contact Number: {contactNumber}

Email Address: {email}

Date of Request: {requestDate}

Equipment Details

Equipment Name: {equipmentName}

Serial Number: {serialNumber}

Location: {location}

Asset Tag (if applicable): {assetTag}

Issue Description

{issueDescription}

Urgency Level

{urgencyLevel}

Additional Remarks

{additionalRemarks}

Parts Required

{#parts}

• {partName} — {quantity}

{/parts}

Affected Departments/Areas

{#affectedAreas}

• {area}

{/affectedAreas}

Attachments Provided

{#attachments}

• {fileName}

{/attachments}

Technician Section

Assigned Technician: {technicianName}

Date Assigned: {assignmentDate}

Repair Details

Work Performed:

{repairDetails}

Materials Used

Completion Status

Date Completed: {completionDate}

Status: {completionStatus}

{#wasFollowUpRequired}

Follow-up Required: Yes

Details: {followUpDetails}

{/wasFollowUpRequired}

{^wasFollowUpRequired}

Follow-up Required: No

{/wasFollowUpRequired}