Electrical Outlet Cover Replacement Request
Submit a request for the replacement of a damaged or missing electrical outlet cover. Please provide detailed information to ensure prompt service.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Building or Facility Name
*
Room Number or Location Description
*
Type of Outlet
*
Standard 2-Prong
Standard 3-Prong
GFCI
USB Outlet
Other
Describe the Issue
*
Is this a safety hazard?
*
Yes, exposed wires or risk of shock
No, just cosmetic or missing cover
Upload a Photo of the Outlet (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Preferred Date for Replacement
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Special Access Instructions (if any)
Additional Comments or Requests
Submit Request
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