Auxiliary Services

Housekeeping Work Order Form

Work Order Details
* Requested By:
* Department:
* Contact Name:
* Email Address:
* Contact Extension:
Custodial Department Request
Work Needed:	Check all that apply: Shampoo Vacuum Sweep Mop Dust Post Contruction Renovation Equipment Discard Equipment Discard Details Type of Equipment: Cleared by Engineering? Yes No Cleared by Safety? Yes No Set Up for Event Scrub/recoat Extract Other Please Specify:
Date Needed:	If no date, explain in the notes area
* Building:
Room:
Move:	Move Needed From: To:
1. Most carpets are shampooed on Friday. Please allow two weeks for work to be performed 2. Average time to complete moves is three to five working days 3. All equipment that are connected to the Xiltrix alarm system must go through Engineering before submitting a move request.
Additional Information:
Reference Number:
Diagram:	I have a diagram to upload (If checked, you will be taken to the upload page once the form is submitted.)
* Security	Enter the code below, including spaces, as it appears to the right. 12 eleven 2023