Facility Management Break Report Form
Use this form to report facility issues or breakdowns requiring maintenance attention.
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 Affected
*
Location of Issue (Building, Floor, Room, etc.)
*
Type of Issue
*
Please Select
Electrical
Plumbing
HVAC
Structural
Cleaning/Sanitation
Security
Other
Urgency Level
*
Critical (Immediate attention required)
High (Within 24 hours)
Moderate (Within 3 days)
Low (Next scheduled maintenance)
Date and Time Issue Was Noticed
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Detailed Description of the Issue
*
Photo or File Upload (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Actions Already Taken (if any)
Submit Report
Should be Empty: