Golden Door Charter School
It is our expectation that all students will achieve;
no exceptions, no excuses.

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  Golden Door Charter School

Custodial Work Request Form
For in-school custodial work requests only.

All fields are required to be filled out

Requested By

Priority Level Emergency - Security or safety concern
Essential - Complete in the next five days
Desirable - Complete as soon as possible

Location/Room Number/Area to be Serviced

Place choose the appropriate action item Clean whiteboard, desks, or floors
Empty pencil sharpener or trash
Fix broken door, window, or tiles
Inspect leak in ceiling
Assess insect problem
Review electrical or plumbing issue
Other maintenance request (please describe below)
Other cleaning request (please describe below)

Describe the Request

Please describe the work requested in sufficient detail that the materials needed to complete the job can be identified.


Date  /  / 



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