Only include 1 repair per form submission.

    Scheme Name or Address

    Flat or Room Number

    Tenants Initials

    What is the repair/ works that are required (please include location within the Flat/ Room)

    Whilst we have a timeframe for completing repairs, is there a concern or risk (to the tenant or others) that we need to know about that means we need to carry out the repair sooner?

    Please provide a photograph of the item/ area that is in need of repair

    How and why did the repair/works arise?

    Other

    If Accidental or Damage, who caused it?

    Is this the first time this has happened? If not, please provide details of previous occasions.

    Does the tenant or appointee agree that they should be liable for the costs?

    Does the Care Provider agree the tenant should be liable for the costs?

    Are there any particular times and days when access will not be available to inspect / carry out the works?

    Please provide your details so that we can contact in regards to this repair.