Maintenance Request

Maintenance Request

Use this form to notify the Maintenance Department of any and all needs.
This form is for notifying the Maintenance Department of any issues occurring within or around your store building. This is not for I.T. Tickets. If you have an issue with your registers, office computers, printers, music, internet connection or any other technology-related issues, please submit an I.T. Ticket using the I.T. Help Desk Form .

Please report all issues separately for tracking purposes. Do not attempt to report multiple issues in one submission.
Name*

First NameLast Name
Store Number*
Store Email*

Confirmation EmailEnter the store or manager e-mail address; then enter it again to confirm in the second box.
Issue with lightingIssue with plumbingIssue with air conditioningIssue with electrical components/wiringIssue with the integrity of the building (Ex.: Windows, Doors, Locks, Ceiling Tiles, Walls)
Priority 1 Examples:
-Broken Windows/Doors -Flooding -Roof Leak -AC/Heat failure during extreme weather

Priority 2 Examples:
-Restroom not functioning -Major lighting outage on sales floor -Damaged fitting room door

Priority 3 Examples:
-Minor plumbing drip/leak -Loose shelving bracket -Cosmetic damage -Fixture Need -Minor lighting issues

For Supply Items like batteries/household lightbulbs, please utilize regular supply order or submit CPO request to purchase locally once approved by DM/RM.
Priority 1 (Immediate Action Required)Priority 2 (Medium Impact to Customers or Sales)Priority 3 (Routine Repair)
What is the Supply/Item? Please include links if possible.
Area that requires maintenance attention:*
If "Other" was chosen, please specify:
Enter the area that requires maintenance's attention, if it was not listed above.
Please describe the issue with as much detail as possible:*
Upload a photo of the issue

Example: If the issue is lighting, upload a photo of the light/bulb.
Cancelof
What fixture/hardware is needed?
YesNo
Select Date of Previous Request(s)*
Thank you for your submission!

This section is for ADMIN use only.
Service ScheduledRequest CompletedUpdate to Request
YesNoNo, but alarm must be disabled
Please provide details of upcoming service:*
Date request was completed:

MonthDayYear
Upload Invoice(s) for service or related expense:

Cancelof
Please provide update below:
Should be Empty: