KMC Online Maintenance Work Order Submission Form

To Submit a Maintenance Work Order Online:

Please complete the online work order webform below
Please be specific about the services you are requesting in the comments section of the webform below (Example: Please move desk to Wellness Building office #17 in the southeast corner of the office)
All work requested outside of normal business hours requires a minimum of 2 weeks’ notice*
- *After hours work is dependent upon staff availability, so please submit your order as soon as possible

Facilities Supervisor:
Elton Baldy
Phone: (530) 625-4261, Ext. 0229

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Name *

Date

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Email *

Phone Number *

Job Location *

Date Services Needed

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Maintenance

Pick-up/Set Up

Move

Remove

Connect

Disconnect

Other

Other Maintenance Service (Please Describe)

Department Requesting Service *

Employee Requesting Service *

Program Manager's Approval *

Yes

Comments: (Specific Details of Request) *

K’ima:w Medical Center
535 Airport Rd
PO Box 1288
Hoopa, CA 95546
Main Phone: (530) 625-4261