Maintenance Request

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E-MAIL COMPLETED FORM TO: maint@asumidsouth.edu

Requester:	Date:

Building/Room No:

Problems and/or Request:
If tagged furniture or equipment is to be moved, please list tag numbers and item descriptions below. Attach additional sheets if more space is needed. If furniture or equipment is to be moved, approval of the Chancellor is required. Tag: Description: Tag: Description:

In the event of potential health and/or safety hazard or an emergency, please contact the Director of Maintenance (6026) or the Associate Vice Chancellor for Student Life immediately.

Electronic Signatures

Date:

Date:

For furniture or equipment moves only:

Date:

FOR OFFICE USE ONLY

Completed by:	Date Completed:

Time spent on the job:

NOTES:

This form requires approval from the Chancellor only if furniture or equipment is being moved. Otherwise, the AVC/VC will forward the form directly to the Director of Maintenance. If this is an office move, the AVC/VC will also forward the form to the Facilities Scheduling Coordinator.