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Run: Maintenance Work Order Request Form

A maintenance work order request form for capturing asset, location, problem, priority, and evidence details before a planner triages the request. Use it to ...

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Requester Information

Full Name (required)

Department (required)

Email Address (required)

Phone / Extension

Optional — provide if you prefer to be reached by phone.

Date of Request (required)

Asset & Location

Asset ID / Equipment Tag Number (required)

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 (required)

Building / Site (required)

Floor / Area / Zone (required)

GPS Location (Optional)

Capture GPS coordinates if submitting from a mobile device in the field.

Problem Description

Work Order Type (required)

Problem Description (required)

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? (required)

Select the date and time the problem was first observed.

Is the Asset Currently Operational? (required)

Production / Operations Impact (required)

Priority & Urgency

Requested Priority (required)

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? (required)

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.

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