Fillable Printable MIS Work Order Form - MHA Nation

MIS Work Order Form - MHA Nation

MHA Nation

MIS Department

404 Frontage Road

New Town, ND 58763

Phone: 701-627-4781 ext. 8236

FAX: 701-627-3614

Please complete the following fields. Work will not be done unless each field is completed.

Name:

Department: Department Location:

Request or Issue (Please be as detailed as possible)

Other Information (i.e. Vendor Name, Phone number, Part number)

MIS Use Only

Time:

Action Taken:

MIS Staff:

Time:

Notes:

MIS Staff:

Follow-up call Work Order Information

Other information (i.e. Repair information)

MIS WORK ORDER FORM

MIS Use Only

Date:

Phone Number:

Date:

Work Order #:

Assigned to MIS Staff:

Once filled out, Work Order can be printed and faxed or turned into the MIS Department