Facilities Maintenance Questionnaire
Please provide information about the maintenance status of the facilities.
Facility Name
Date of Inspection
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Maintenance Issues Observed
Urgency Level
Low
Medium
High
Critical
Maintenance Type
Electrical
Plumbing
HVAC
Structural
Cleaning
Landscaping
Other
Additional Comments
Submit
Should be Empty: