Maintenance Fault and Condition Reporting Form

1
Are You Reporting a Fault Or Condition* This field is required.Here at AMIC we love to hear from the congregation positive and negative feedback
Reporting a Fault
Reporting a Condition
2
What Site Are You Reporting From* This field is required.
Central Mosque (Fredrick Street)
Spital Mosque
3
Which Area is Your Observation In (Spital)* This field is required.
Mosque External
Entrance / Shoe Rack Area
Main Prayer Area (Imam Area)
Side Hall
Downstairs Hall (Library)
Upstair Rooms
Toilets
Kitchen
4
Which Area Is Your Observation In (Fredrick Street)* This field is required.This will help us create a database and assist in establishing PMR system to avoid re-occurrence
Outside Mosque Compound
Parking
Mens Entrance
Ladies Entrance
Mens Staircase
Ladies Staircase
Ground Floor
1st Floor
2nd Floor
Other
5
You Selected Other - Please Tell Us Where* This field is required.
6
You Selected Ground Floor* This field is required.Please select Mens Main Prayer Hall if you do not see any suitable option
Toilets
Main Prayer Hall
Side Prayer Hall
Elevator
Kitchen
Ground Floor Alley
7
You Selected 1st Floor* This field is required.Please select Ladies Main Prayer Hall if you do not see any suitable option
Toilets
Main Prayer Hall
Side Prayer Hall
Elevator
Kitchen
1st Floor Alley
Nursery
8
You Selected 2nd Floor* This field is required.Please select Main Alley if you do not see any suitable option
Toilets
Kitchen
Main Alley
Classroom
9
You Selected Class Room - Please Report Room Number* This field is required.Class room numbers are generally found on the door of the respective room
10
What Category Of A Fault Is This* This field is required.
Cleanliness
Heating
Lighting
Damage
Equipment
Security
Other
11
You Selected Other Then Please Tell Us WhatClick Next if Unkown
12
Give Us a Brief Description Of The Fault / ConditionYour First Hand Report Is Very Important To Us
Huge
Large
Normal
Small
Ok
Ok
13
Please Send Us a PhotographPicture speaks a thousand words
14
Tell Us Your Name* This field is required.Who is earning the Hasa'ana for reporting this
Mr.
Mr.
Mrs.
Prefix
First Name
Last Name
15
What Is Your Email Address* This field is required.We want to share updates on improvements after your report
example@example.com
16
Phone NumberConnect with the AMIC Community
Area Code
Phone Number
17
Do you want to join the AMIC Cleanliness Avengers!!!We will add you to a whatsapp group to get you more involved major cleaning events of the mosque
Yes, I want to be more involved
No, I will contribute other way
18
Jazak' Allahu Khairan Katheera for playing your part - You Are A Hero!!!We Aim To Resolve All Issues Within Two Weeks
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