---
title: Assisted Living Facility Maintenance Request Form Template | Paperform
description: Specialized maintenance request form for assisted living facilities with fall hazard priority, resident care impact tracking, and automatic family notifications.
url: "https://paperform.co/templates/assisted-living-facility-maintenance-request-form"
type: static
generatedAt: "2026-03-28T00:43:04.909Z"
---

[← Back to free form templates](/templates/)    ![Assisted Living Facility Maintenance Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/assisted-living-facility-maintenance-request-form.png)
    [Preview](https://_preview.paperform.co/ai-template/assisted-living-facility-maintenance-request-form) [Use this template for free](/create?ai-template=assisted-living-facility-maintenance-request-form)    [Healthcare & Medical Forms](/templates/category/healthcare/)[Facilities & Workspace](/templates/category/facilities-workspace/) [Healthcare](/templates/industry/healthcare/)[Senior Care](/templates/industry/senior-care/) [Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Caregiver](/templates/role/caregiver/)[Facilities Manager](/templates/role/facilities-manager/)     About this free form template
Managing maintenance in an assisted living facility requires more than just tracking repairs—it demands an acute awareness of how every issue impacts resident safety, comfort, and care quality. This **Assisted Living Facility Maintenance Request Form** is purpose-built for senior care communities to streamline maintenance operations while keeping resident wellbeing at the forefront.

Unlike generic maintenance forms, this template includes specialized fields for **fall hazard priority levels**, **resident care impact assessment**, and **family notification triggers**. Staff can quickly categorize issues by urgency and automatically flag concerns that require immediate family communication, ensuring transparency and compliance with care standards.

With Paperform's conditional logic, the form adapts based on the type of issue reported—HVAC problems, accessibility hazards, equipment malfunctions, or room-specific repairs all follow tailored workflows. You can set up automatic notifications to maintenance teams, care coordinators, and even family members when critical safety issues are identified.

Integration with **Stepper** (stepper.io) takes your maintenance workflow even further. Route urgent fall hazard tickets directly to your facilities director, create work orders in your maintenance management system, log incidents in resident care records, and send templated family notifications—all triggered automatically from form submissions. This removes manual handoffs and ensures nothing falls through the cracks.

For assisted living administrators, directors of nursing, and facilities managers, this template bridges the gap between operational efficiency and compassionate care. It's designed for environments where maintenance isn't just about fixing things—it's about protecting dignity, safety, and peace of mind for residents and their families.

Paperform is trusted by healthcare and senior care facilities worldwide, with SOC 2 Type II compliance and robust security features that protect sensitive resident information while streamlining your daily operations.
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