FACILITIES REQUEST FORM
PLEASE MAKE SURE TO INDICATE ANY AND ALL FACILITIES REQUESTS BOTH INSIDE AND OUTSIDE OF CLASSROOM.
Room Number or Location
Please check off all items related to your facilities request:
Broken Light Fixture
Light Bulb Replacement
Water Damage (Ceiling, Floor, Wall, Door)
Damage or Missing Ceiling Tiles
Missing/Broken Floor Tiles
Inoperable or Exposed Electrical Outlet(s)
Holes in Floor/Wall
Broken or Inoperable Classroom Sink
Broken Cabinet/Missing Locks
Evidence of Mold
Termite Damage and/or Activity
Air Conditioning Issue
Teacher Desk or Chair Needed
Inoperable Ethernet Port
Whiteboard Needed or Replacement of Whiteboard
Telephone not Working
Please Add Detail to the issue noted above to help ensure your request is addressed properly:
FOR ADMINISTRATOR/FACILITIES STAFF ONLY:
Action taken to address Facilities Request
Action Taken by School:
Person who Addressed Request:
A copy of your responses will be emailed to the address you provided.
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