Free Electrical Repair Work Order Form

Please fill out this form completely to request electrical repairs or maintenance services.
Work Order Number
Date of Request
Name
Phone Number
Location Address of Electrical Issue
Type of Request
Electrical Wiring Repair
Equipment/Appliance Repair
Power Outage/Failure
Description of Problem
Priority Level
High (Safety risk or major disruption)
Medium (Non-critical but urgent)
Low (Routine maintenance)
Request Completion Date
Additional Information
Provide any additional comments, notes, etc.
Approved by:
Approval Date
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