Maintenance Request

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In order to improve efficiency, at least one picture will be required of the item requiring maintenance. If you don't have a picture on this device already, make sure you're using a device capable of taking one (like an iPad)!

As of May 6, 2019, Maintenance Managers are responsible for geographic areas as follows: Matt (East) and Corey (West).

Click here for a listing of which support locations are assigned East/West.

Date/Time*

Support Location*

Address*

Type of Request*

Maintenance Request Vehicle Maintenance Request Health Care Equipment Maintenance (INCLUDING VEHICLE LIFTS)

Maintenance Required (Be specific. What is the problem? With what? Where is it? When did it start? Please list all requests on one form.)*

Vehicle Maintenance Request

Vehicle Description*

Is the vehicle driveable?*

Yes No

Required Action*

I will contact Gerti at 519-890-3480 or Matt (East) at 519-999-0760 or Corey (West) at 519-562-4720.

Is this an emergency?*

Yes No

Required Action*

I will contact Gerti at 519-890-3480 or Matt (East) at 519-999-0760 or Corey (West) at 519-562-4720

What is the best contact number to reach you?*

Health Care Equipment Maintenance

Equipment Requiring Maintenance*

Lift Number*

Make

Model

Vehicle Description*

Is this an emergency?

Yes No

Contact Gerti (519-890-3480) or Rob (519-800-0000)*

I will contact one of them immediately

Contact Gerti (519-890-3480) or Rob (519-800-0000) - Copy*

I will contact one of them immediately

Best Phone Number for Follow-up*

At least one picture is required*

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Staff Member Completing This Report*

First Name

Last Name

Email for confirmation

Signature

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This form gets submitted to the appropriate Support Manager for approval before they are forwarded to Maintenance.

If the request is "Urgent," the Maintenance department is notified immediately.

If there is a near-miss involved, the Director HR and Manager Health and Wellness are notified.