"Repair and Maintenance Work Order Form" - Florida

The Florida Department of Juvenile Justice has released this version of the "Repair and Maintenance Work Order Form" on March 18, 2005.

This form may be used by all Florida residents: download the printable PDF by clicking the link below and use it according to the applicable legal guidelines.

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Download "Repair and Maintenance Work Order Form" - Florida

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Work Order Number:
REPAIR AND MAINTENANCE WORK ORDER
(Please Check the Appropriate Section)
Residential Services
Detention Services
Probation/Community Corrections
DATE OF REQUEST:
PERSON SUBMITTING REQUEST:
(NAME)
(PHONE)
PROGRAM:
ADDRESS OF PROGRAM:
(CITY)
(COUNTY)
(ZIP CODE)
PROGRAM CONTACT AND PHONE NUMBER
CONTRACT MANAGER AND PHONE NUMBER
Major Maintenance Fund
Yes
No
If yes, insert current balance
GENERAL SERVICES LIAISON
(NAME)
(PHONE)
PROGRAM AREA OR ITEM NEEDING REPAIR:
DESCRIPTION OF PROBLEM:
RECOMMENDED REPAIR OR CORRECTION:
PROPOSED AMOUNT OF REPAIRS:
(Attach quotes as required by State Purchasing Manual
)
Office
Date Received
Date Submitted
Signature
Regional Director
Assistant Secretary
Identify Funding Source:
Facility Services
CC: Residential Services Administrator (Upon signature by Regional Director)
General Services Liaison (Upon signature by Regional Director)
Save As
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Print Form
Revised 3/18/05
Page 1 of 2
Work Order Number:
REPAIR AND MAINTENANCE WORK ORDER
(Please Check the Appropriate Section)
Residential Services
Detention Services
Probation/Community Corrections
DATE OF REQUEST:
PERSON SUBMITTING REQUEST:
(NAME)
(PHONE)
PROGRAM:
ADDRESS OF PROGRAM:
(CITY)
(COUNTY)
(ZIP CODE)
PROGRAM CONTACT AND PHONE NUMBER
CONTRACT MANAGER AND PHONE NUMBER
Major Maintenance Fund
Yes
No
If yes, insert current balance
GENERAL SERVICES LIAISON
(NAME)
(PHONE)
PROGRAM AREA OR ITEM NEEDING REPAIR:
DESCRIPTION OF PROBLEM:
RECOMMENDED REPAIR OR CORRECTION:
PROPOSED AMOUNT OF REPAIRS:
(Attach quotes as required by State Purchasing Manual
)
Office
Date Received
Date Submitted
Signature
Regional Director
Assistant Secretary
Identify Funding Source:
Facility Services
CC: Residential Services Administrator (Upon signature by Regional Director)
General Services Liaison (Upon signature by Regional Director)
Save As
Reset/Clear Form
Print Form
Revised 3/18/05
Page 1 of 2
Work Order Number:
DEPARTMENT OF JUVENILE JUSTICE/FACILITY SERVICES USE
DATE:
FUNDING AMOUNT REQUIRED:
EVALUATION/RECOMMENDATION:
cc: RSA General Services Liaison
Note: When funding is approved for the work order projects, Facility Services will notify the appropriate parties.
Additional Comments:
Additional Comments:
Revised 3/18/05
Page 2 of 2
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