Building Maintenance Request Form

Name of person submitting maintenance request *

Phone number of person submitting form *

Email Address *

Building Address * (ie: 200 Victoria Square, Adelaide SA 5000)

Department Name (if applicable)

Floor Level or location of issue *

Priority Level (refer to table listed on 'Help Desk Responsibilities' page for response times) *
-- Please Select --1234

Description of issue/maintenance required *
Please include as much information as possible (eg: location of door, type of spill, entry conditions) to allow us to assess and respond in a timely manner etc.

Is the maintenance request a result of
-- Please Select --AccidentWear & tearVandalism / Break inOther

If other please specify

To assist describing the issue, a file or photo may be attached

Site contact name *

Site contact email *

Site contact phone number *

Project

Task

Other Cost Code (If Applicable)