Trinity School of Medicine Residence Hall Maintenance Request Form

Instructions: Please complete upper portion of form and submit by email only to: sbrowne@tusom.org;sallyaw@trinityschoolofmedicine.org;khollers@trinityschoolofmedicine.org Reported By (Name): E-Mail Address:

Date of Request:

Housing Complex (Ratho Mill or Canash Beach)

Building Number (If Applicable)

Unit Number

Please describe maintenance issue:

For School Use Only:

Nature & description of repairs to correct issue:

Date Reviewed: Visually inspected by Repairs authorized by Estimated Cost of repair(s): Date Date Work assigned to Date Date work initiated Date work completed Days to complete work

Version 20120220V2