WORK ORDER REQUEST FORM
HCCS – MAINTENANCE DEPARTMENT
West Loop Center
FAX NO. 713-718-7932
Requester Name: __________________________ Date: _____________________
Department: _______________________________ Telephone: ________________
Location: _____________________________________ Urgent: Yes_____ No_____
Room: ______________
Description of Work Order Requested:
-----------------------Maintenance Use Only------------------------
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Description of completed Work Order and Material Used:
Completed By: _____________________________ Date: _____________________________
Time Started: _____________________________ Time Ended: _______________________
The HCCS-Maintenance Department receives and process request work orders daily. Our overall goals are to
schedule and complete these services in a timely manner. In order to perfect our goals, each Campus must
complete a work order form and return to the Maintenance office. Thank you in advance for your cooperation.