Locker Maintenance Request Form
Report locker issues and request repairs or servicing. Please complete all fields related to locker maintenance operations.
Requester Full Name
*
First Name
Last Name
Requester Email Address
*
example@example.com
Requester Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Location / Building or Facility
*
Locker Number or Identifier
*
Type of Issue
*
Please Select
Lock malfunction
Door jammed
Broken handle
Missing parts
Other
Issue Severity / Urgency
*
Critical (Immediate attention required)
High (Affects daily use)
Moderate (Needs repair soon)
Low (Minor inconvenience)
Detailed Problem Description
*
Date Issue Was Noticed
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is the locker currently usable?
*
Yes
No
Partially
Preferred Access/Repair Time (if applicable)
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Submit Maintenance Request
Should be Empty: