Work Order Form printable pdf download

Butler R-V School District

Work Order Form

Custodial and maintenance tasks that need to be requested are to be identified on this form as provided. They

then need to turn them in to the building principal for approval. Faculty and staff are to use this form or, in an

emergency, visit directly with the building principal when custodial/maintenance needs are identified. After the

principal approves and sign the work order, they are to be forwarded to the superintendent’s office for approval.

The superintendent and maintenance staff will prioritize items for completion.

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WORK ORDER – COMPLETED BY PERSON MAKING REQUEST

Teacher/Staff Member ______________________ Teacher Plan Time: _________________

Date _______

Location _____________

Services Requested: ___________________________________________________________

____________________________________________________________________________

_____________________________________________________________________________

________________________

___________

_______________________ ___________

Principal’s Signature

Date

Superintendent’s Signature

Date

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THIS SECTION TO BE COMPLETED BY MAINTENANCE STAFF

Status of request – Please list approximate date of completion if work can be done by our staff.

If work cannot be done by our staff, please list recommended option.

Approximate date of completion

Other option _________________________________________________________________

____________________________

___________

Maintenance Staff Signature

Date

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THIS SECTION TO BE COMPLETED BY SUPERINTENDENT

______________________________ ___________

Superintendent Signature

Date Approved

Work Order Form