Technical_Exhibit_05_-_Work_Order_Form_(27_May_2015).docx

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Troop Appliance Maintenance & Repair of and Dryer Duct Cleaning at Joint Base Lewis-McChord, Washington
Solicitation number
W911S8-16-R-0003
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Technical_Exhibit_05_-_Work_Order_Form

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TECHNICAL EXHIBIT 5

WORK ORDER FORM

APPLIANCE WORK ORDER

PART A (this is used for service calls and simple repairs)

1. Date Received: _________________; Priority: __________; FSBP Work Order #:_________________

2. Building Number: ______________; Floor Number: ________; Room Number: ______________________

3. Requestor: ____________________

4. POC: ___________________________________________

a. Duty Phone: ______________________________

b. Alternate Phone: ___________________________

5. Work Requested (problem): _________________________________________________________________

6. Mechanics Signature: ___________________________

7. Occupants Signature: ___________________________

8. Date Completed: _______________________________

PART B (this is used for extensive repairs and disconnect/install actions)

1. Parts Required: ___________________________________________________________________________

2. Parts Installed: ___________________________________________________________________________

3. Appointment Info (if applicable):

4. Appliance Ops Checked (pass/fail/date): _____________________________________________________

PARTC (information on newly installed appliance)

1. Make: __________________________________

2. Model Number: __________________________

3. Serial Number: __________________________

PART D (notes)

File details come from the government source that posted it. Updated .