Work/Service Request Form
Work Order No. _ (To be filled in by Service Desk)
Requestor’s Name : Ahmed Harb
Req. Dept. Wells Requestor’s Phone/Email: 07827803132
Reported Date & Time: 28-Sep-2018
Location: TMC CAMP
Asset: Pannel tripping Issue in D-7 and D-8 Roos
Comments:
The panel locates at D-7 room, it's tripping from time to time.
Below to be filled in by Facilities Management
Approved Disapproved
Service Desk Lead Print Name_ Signature_ Date
FM-S/Contract Specialist (If needed): Print Name _______Signature_ __Date _
Materials Used: (To be filled in by Service Provider)
Materials Used Description
Department Assigned:
Date/Time Work Started Date/Time Work Completed
Completed by: Print Name Signature_ Date _
Department Lead Verification: Print Name __________________ Signature_____________ Date________
Requestor’s confirmation: Print name: Signature: Date
This form is to be used for any related requests to the Facilities Management Department. After completion, the form to be
sent to SIPD-FM-Service-Desk@shell.com
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