Gardena High School


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Maintenance/Custodial Request Form

Requested By:

Room or Location of problem:

Room Phone #:

The problem noted below is brought to your attention for your information and assistance.

No paper towels in restroom
No toilet paper in restroom
Restroom trash full
Soap dispenser empty
Classroom trashcan full
Trash in lunch area
Trash along bungalows
Trash along outside fence
Trash in parking lot
Flag(s) not raised
Safety hazard/liquid spill on floor
Photocopier paper out in office
Electrical power outage
Classroom floor dirty
Hallway floor dirty/gum
Pest control (ants/bugs)
Door/gate not locked
Chairs
Other (specify below)

Graffiti
Heating or AC
Lighting problems
Soap dispenser broken
Toilet stopped up
Toilet handle broken
Sink stopped up
Broken towel dispenser
Broken tissue dispenser
Damaged/scratched mirror
Leaky faucets
Leaking roof
Broken furniture
Broken door
Broken lock on door
Safety hazard (specify below)
Furniture needs to be moved
Need student desk chairs
Need A table (specify below)

Remarks: