service request form · 2019. 12. 11. · service requests to ceo for approval. effective...
TRANSCRIPT
Implemented – Aug 2007 Revised – Sep 2008, Jan 2009, Apr 2009, Aug 2012, Aug 2015
An Equal Opportunity / Affirmative Action Employer
SERVICE REQUEST FORMPLEASE NOTE: FACILITIES WILL FORWARD ANY NON-REGULAR MAINTENANCE
SERVICE REQUESTS TO CEO FOR APPROVAL.Effective immediately this completed form must be faxed, sent via interoffice mail or hand delivered to the Department priorto any service being provided; no other method will be processed (e.g. email or phone calls), unless it is an emergency!
Departmental Information
(Signature)
CEO APPROVAL:(Signature)
Project Location (Please be specific)
Work Request Type (Please be specific)
For Office Use Only: PWFM Supervisor Approval Signature: _____________________________________________________________Priority: Low Medium High Urgent
County of Imperial Public Works works for the public
PUBLIC WORKS DEPARTMENT
County of Imperial Department of Public Works Facilities ManagementPhone No: (442) 265-1823
FAX ALL SERVICE REQUESTS TO FAX NO: (442) 265-1858Email: [email protected]
Department:
Account No.
Authorizing Supervisor:
Date:
Contact Person:
Phone No:
Requested By:
Electrical:
Air Conditioner/Heater:
Janitorial:
Plumbing:
Structural:
Other: