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Facilities Maintenance Work Request Form

  1. Grey highlighted areas denotes for internal use only.

  2. Date Assigned:

  3. Issued To:

  4. Work Order #:

  5. Repair, Request or Comment Form

  6. Return to the Facilities Maintenance Office by Fax number at (904) 879-3751 or email sfontes@nassaucountyfl.com or tconley@nassaucountyfl.com for service. In case of Emergency after 5pm, call (904) 430-3156.

  7. Date Started:

  8. Total Man Hours:

  9. ADA:

  10. Date Finished:

  11. Travel Time:

  12. CM NO.:

  13. Turned In:

  14. Estimated Cost:

  15. P.O. NO.:

  16. Comments



  17. Technician Signature


  18. Leave This Blank:

  19. This field is not part of the form submission.