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:
Date:
Work Order #:
Assigned to MIS Staff:
Once filled out, Work Order can be printed and faxed or turned into the MIS Department
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MIS Work Order Form - MHA Nation PDF

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