Facility Maintenance Scenario Assessment Form
Complete this form to assess facility maintenance scenarios, evaluate issue severity, and recommend the next steps.
Scenario Title
*
Scenario Description
*
Affected Area or Location
*
Please Select
Restroom
Lobby
Office
Hallway
Mechanical Room
Parking Area
Exterior Grounds
Other
Maintenance Category
*
Electrical
Plumbing
HVAC
Structural
Cleaning
Other
Condition Severity
*
Minor
1
2
3
4
Critical
5
1 is Minor, 5 is Critical
Urgency Level
*
Immediate
High (within 24 hours)
Medium (within 3 days)
Low (within 1 week)
Safety Impact
*
No Risk
Potential Risk
Serious Risk
Possible Cause
Please Select
Wear and Tear
Accidental Damage
Faulty Installation
Neglected Maintenance
Unknown
Other
Resource Needs Assessment
Rows
Not Required
Required
Spare Parts
1
2
Special Tools
3
4
External Contractor
5
6
Additional Staff
7
8
Recommended Next Step
*
Please Select
Immediate Repair
Schedule Maintenance
Monitor Situation
Escalate to Management
Other
Submit Assessment
Should be Empty: