UNIVERSITY OF MINNESOTA DULUTH

FACILITIES MANAGEMENT

Work Request Form
Please do not use this form to report situations that could result in fire, major property damage, safety hazards, or jeopardize campus security.
For immediate assistance or questions, please call x8262 or follow Emergency Procedures.

Fields with an * must be filled in.

Requestor and Contact Information

Name: *
(First and Last)
Phone: *
Email: *
(username@server.name)
Department: *

Location of Maintenance Need

Building OR Site/Equipment: *
Floor:
Room:

Description of Requested Maintenance

Description of Work:*

Account Information

Fund (4) DeptID (5) Account (6) Program (5)
ChartField1 (10) ChartField2 (10) Fin EmplID (8) Cost Share (2)
Sponsored:
Fund (4) DeptID (5) Account (6) PCBU (5) Project (8) Activity (1)
ChartField1 (10) ChartField2 (10) Fin EmplID (8) Cost Share (2)

Thank you for Submitting this request

NOTE:

If this maintenace requires charges, you will be notified before work begins.