MAINTENANCE REQUEST & ISSUES FORM
Please complete below for any building maintenance and social living standard issues.
REPORTER DETAILS
Reporter
*
Please Select
Student
Staff
Student Full Names
*
Title
First Name
Middle Name
Surname
Staff Full Names
*
Title
First Name
Middle Name
Surname
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Name of Residence
*
Please Select
Pura Vida (Kabokweni)
Cecil S Complex #1 (Kabokweni)
Cecil Complex #1 (Msholozi)
Cecil Complex #2 (Kabokweni)
Cecil Complex #3 (Kabokweni)
Room Number
*
MAINTENANCE DETAILS
Maintenance Category
*
Please Select
Electrical
Carpentry (Wood)
Bathroom & Toilet Equipment
Steel & Aluminium
Fire Equipment
General Building
House Break-Inn
Electrical Maintenance Item
*
Please Select
Light
Light switch
Plug
Television (TV)
Washing Machine
Tumble Dryer
Microwave
Kettle
Stove
Swimming Pool Motor
Distribution Box
Electrical Fence
CCTV
Inverter
Generator
Printer
Screen Projector
Treadmill
Fan
Geyser
Wi-Fi
Carpentry (Wood) Item
*
Please Select
Door
Wardrobe
Study Desk
Study Chair
Bookshelve
Office Desk
Office Chair
Cupboard
Couch
Desk
Bathroom & Toilet Item
*
Please Select
Basin
Toilet seat
Cistern (Water Box)
Shower tiles
Shower cap
Shower-mixer
Taps
Urinal
Bathtub
Mirror
General Building Item
*
Please Select
Wall
Floor Tiles
Roof
Ceiling
Stairs
Signage
Swimming Pool
Braai area
Windows
Water pipe(s)
Steel & Aluminium Item
*
Please Select
Stair Rails
Palisade
Gate
Window Frame
Statue
Fence
Razor wire
Fire Equipment Item
*
Please Select
Stair Rails
Palisade
Gate
Window Frame
Statue
Fence
Razor wire
House Break-Inn
*
Please Select
Stolen Phone
Stolen Laptop
Stolen Clothes
Stolen Tekkies
Stolen Cutlery & Crockery
Location of the issue
*
Please Select
Bedroom
Bathroom
Kitchen
Office
TV Area
Swimming Pool area
Braai area
Parking
Game area
Gym
Boardroom
Stairs
Passage
Laundry area
Washing Line area
Gate Entrance
DETAIL DESCRIPTION OF THE ISSUE
Comments
Explain what is wrong with the item being reported.
Photo of the item 1
*
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Photo of the item 2
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Photo of the item 3
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Photo of the item 4
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Signature
*
Date
*
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Month
-
Day
Year
Date
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