Maintenance Work Order Request Form

Standard intake form for submitting maintenance work order requests, capturing asset ID, problem description, priority, and location so a planner can validate and triage before the request enters the backlog.

Requester Information

• Full Name
• Department
• Email Address
• Phone / Extension
  Optional — provide if you prefer to be reached by phone.
• Date of Request

Asset & Location

• Asset ID / Equipment Tag Number
  Enter the asset tag or equipment ID found on the physical label or in the CMMS. If unknown, describe the equipment in the field below.
• Asset / Equipment Name
• Building / Site
• Floor / Area / Zone
• GPS Location (Optional)
  Capture GPS coordinates if submitting from a mobile device in the field.

Problem Description

• Work Order Type
• Problem Description
  Include observable symptoms, when the issue started, and any conditions that trigger or worsen the problem.
• Failure Mode / Symptom Category
  Select all that apply to help route to the right trade.
• When Did the Issue Start?
  Select the date and time the problem was first observed.
• Is the Asset Currently Operational?
• Production / Operations Impact

Priority & Urgency

• Requested Priority
  Select the priority level that best matches the situation. Emergency requests should also be reported verbally to your supervisor.
• Does this issue present a safety hazard?
• Describe the Safety Hazard
  If a safety hazard is present, also notify your supervisor immediately and consider isolating the area per your site's lockout/tagout (LOTO) procedure (OSHA 29 CFR 1910.147).
• Required Completion Date (if applicable)
  Enter only if there is a hard deadline (e.g., regulatory inspection, planned shutdown window).

Supporting Evidence

• Photos of the Issue
  Upload clear photos showing the defect, damage, or abnormal condition. Multiple images accepted.
• Supporting Documents
  Attach any relevant documents such as error logs, sensor readings, previous work order references, or operator reports.
• Related Previous Work Order Number (if any)
  If this is a recurring issue or related to a prior work order, enter the reference number.

Additional Notes & Planner Use

• Additional Notes from Requester
• Special Access or Permits Required?
  Select any known access requirements so the planner can arrange permits in advance.
• [Planner] Validation Status
  To be completed by the maintenance planner during triage review.
• [Planner] Triage Notes
  To be completed by the maintenance planner. Record validation outcome, priority adjustment rationale, or follow-up actions.