Locker Issue Report Form
Please use this form to report any problems or issues with your assigned locker. Complete all relevant sections to help us resolve your issue promptly.
Your Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Department or Area
Please Select
Administration
Student
Faculty
Maintenance
Other
Locker Location
*
Locker Number
*
Type of Issue
*
Lock not working
Door jammed
Lost key or combination
Physical damage
Other
Describe the Issue in Detail
*
When did you first notice the issue?
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How urgent is this issue?
*
Critical (locker cannot be used)
High (major inconvenience)
Moderate (can be used with difficulty)
Low (minor issue, does not affect use)
Upload a Photo or File (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Report
Should be Empty: