MAINTENANCE Employee Name Employee Number Employee Email Employee Phone Number Department / Area Supervisor Name Machine / Vehicle / Unit Name Machine/Truck/Unit Exact Location Describe FULLY the maintenance need/repair request Has the supervisor or manager in that area been notified the maintenance or repair need? Yes No Is this repair request URGENT? Yes No Is the maintenance or repair request due to an accident or safety concern? Yes No Employee Signature Report Date Complete the Maintenance/Repair Request Form and return it to th Maintenance Department. Be sure and fill your contact inforrnation above so keep in contact with you regarding your request. If them are any questions regarding this form or request please contact: Submit
