Fitness Center Repair Form
Time
Hour Minutes
AM
PM
AM/PM Option
Date
-
Year
-
Month
Day
Date
Name
First Name
Last Name
Email
example@example.com
Please select which floor the broken equipment is on:
Upper Level
Lower Level
Broken machine name/description:
Details of the damage to the equipment:
Is the equipment still able to be used safely?
Yes
No
Not sure
Did you witness someone intentionally break the equipment?
Yes (please describe below in "additional information")
No
Picture of broken equipment:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Additional information:
Signature
Submit
Submit
Should be Empty: