Maintenance Needs
Date:______________
Custodian:_________________________________________
Location:___________________
Deficiency
Door or door glass
Missing or stained ceiling tile
Broken light switch or receptacle cover
Broken floor tile
Torn carpet
Broken window
Pencil sharpener
Damaged desk
Commode or urinal
Mirror
Wall
Partition
Light fixture
Pest (ants, roach, etc.):______________________________
Pest Pressure (clutter, food, pets):______________________
Other:___________________________________________
Give completed form to your supervisor!!