Repair and Maintenance Request Survey Question Title * 1. Name Question Title * 2. Project Number Question Title * 3. Today's Date Date Date Question Title * 4. Unit Number Question Title * 5. Current Location Of Equipment? Question Title * 6. When Was The Issue Noticed? Question Title * 7. Please Describe The Issue Question Title * 8. Have You Notified The Paragon PM or HSE? Yes No Other (please specify) Question Title * 9. Can You Continue Working Without This Equipment Or Continue With The Defective Equipment (Must Not Use If It Presents A Safety Hazard)? If No, Call The Logistics Coordinator Immediately at 587-460-0872. If Yes, The Logistics Coordinator Will Be In Touch Within Two Business Days. Yes No Other (please specify) Done