Maintenance Or Custodial Work Request
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Date of Request: ____/____/_____
Requesting Party:________________
Work Location: _________________
Description of work/repair:
________________________________
Requested Priority:
[___] High - Must be done within 24 hours.
[___] Medium - Within the week.
[___] Low - When you get a chance.
For Office Use Only:
Date Reviewed: ____/____/_____
Priority Assigned: _____________
Authorized By: _________________
Comment: ______________________
Date Work Completed:____/____/_____
Number of Days to Complete: ______
Work Assigned To:
________________________________
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