Facility issue report
Collect building, floor, issue type, severity and a photo so facilities staff can act right away.
Free to use. Start with your Google account and the form opens in the editor.
Who it is for
For facilities and office managers who take breakage reports and track them from assignment to fixed.
What you get
- 11 questions on 1 pages
- 1 logic rules that show follow-up questions or update calculations
- Inbox statuses: New, Assigned, In progress, Fixed, Closed, Spam
- An email alert for every new response
- Everything stays editable: questions, options, logic and statuses
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Template preview
Facility issue report
Found something broken? Tell us where and what, and the facilities team will take a look. If it is dangerous, move to safety first.
Location
Building
Required- 1.Main building
- 2.Annex
- 3.Warehouse
- 4.Parking lot
- 5.Outdoor area
Floor
Required- 1.Basement 2
- 2.Basement 1
- 3.1st floor
- 4.2nd floor
- 5.3rd floor
- 6.4th floor
- 7.5th floor or above
- 8.Rooftop
Exact spot (optional)
e.g. East meeting room BShort text
The problem
What type of issue is it?
Required- 1.Electrical or lighting
- 2.Plumbing or leak
- 3.Heating, cooling or ventilation
- 4.Office equipment or fixtures
- 5.Doors, windows, walls or floors
- 6.Elevator
- 7.Other
How severe is it?
Required- Minor - still usable
- Moderate - inconvenient
- Major - out of service
Describe what happened
RequiredWhen it started and what you noticed.Long text
Photo (optional)
File upload
Is there a safety hazard?
Required- Yes, it is hazardous
- No
What immediate action have you taken?
e.g. Blocked off the area and switched off the power.Long text
Logic
WhenIs there a safety hazard?isYes, it is hazardous
ThenshowWhat immediate action have you taken?
andrequire an answer toWhat immediate action have you taken?
Reporter
Your name
RequiredShort text
Phone (optional)
Only used if we need to follow up.Phone
Ending page
Thanks, your report is in. The facilities team will handle it.