MRHC Maintenance Request

Complete this form, with details, for all maintenance requests.

Call Chuck 440-822-0555 or 440-329-3734 Monday – Friday between 8:45 a.m. – 4:45 p.m. for emergency maintenance problems. If Chuck is unavailable, call 440-329-3734 and speak to Jennifer Ryan. After hours and weekend emergencies, please follow Maintenance Procedure for Tenants/ Service Provider Representatives

Please select one: *

Health and Safety Issue
Not a Health and Safety Issue

Address: *

Address Line 1

Address Line 2

City

State

Supervisor/Manager: *

Supervisor Phone: *

Supervisor Email: *

Date of Problem Discovery: *

staff discovered can

Name of person who discovered issue: *

Nature of Problem [be specific & give details – location/room, cause (known/suspected), extent of damage, etc.]: *

Location/room? If bedroom, is it locked?

Steps staff have taken to assess, temporarily or permanently correct problem: *

Date and time staff can be contacted at the home: *

Name *

First

Last

Date submitted: *

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