Request for Custodial Work

Please complete the form below. Required fields marked *

One request per form.

Requested by:*

Answer required for "Requested by:"

DOE email address*

Answer required for "DOE email address"

Location:

If applicable, please be as specific in your request as possible.

Answer required for "Location:"

Nature of repair:

Electrical:

Answer required for "Electrical:"

Light out

Outlet

Switch

Fuse breaker

Plumbing:

Answer required for "Plumbing:"

Faucet

Sink

Toilet

Urinal

Leak

Graffiti

Answer required for "Graffiti"

Walls

Ceiling

Tiles

Door

Furniture

Glass

Answer required for "Glass"

Window pane

Door

Other:

Locksmith

Answer required for "Locksmith"

Keys

Cylinders

Locks

Padlock

Hasps

Door knobs

Door

Answer required for "Door"

Door hinge

Door stop needed

Broken / Missing

Answer required for "Broken / Missing"

Air Conditioner

Air Circulator

Air Purifier

Classroom Door Lockdown Shade

Door Stop

Window Shade

Broken Other:

Please state the item which is broken. Indicate if you would like the item repaired or discarded.

Answer required for "Broken Other:"

UHaul:

Please describe the item which needs to be moved. State where it is currently located and where it needs to be moved to. In addition, label the item "move this to room X." In room X, please label "Place item here."

Answer required for "UHaul:"

Comments:

Answer required for "Comments:"

Only 1 request can be made per form. Multiple requests require multiple forms. *

Answer required for "Only 1 request can be made per form. Multiple requests require multiple forms. "

I understand.

Please fix the highlighted areas below before submitting.

Request for Custodial Work