Capital Improvement Requests
Capital Improvement Requests
Submitting as:
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Site Location
Select a site...
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SECTION 1 — Request Details
1. Type of Capital Request (Select all that apply)
Equipment replacement
Equipment upgrade
Facility repair
Facility remodel
Technology upgrade
Safety enhancement
Building/structural improvement
Utility-related repair
Vehicle / fleet equipment
Other
2. Equipment or Area Involved
3. Description of the Request
4. Photo / File Upload (Optional)
Take Photo
Upload File
File attached
SECTION 2 — Impact Assessment
1. Operational Impact
Select an answer...
High impact (affects daily operations)
Moderate impact
Low impact
No current impact (preventative)
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2. Customer Experience Impact
Select an answer...
Significant negative impact
Minor negative impact
Neutral
Improvement opportunity
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3. Safety Impact
Select an answer...
Immediate safety risk
Moderate safety concern
Potential future risk
No safety impact
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4. Does this impact revenue or site throughput?
Select an answer...
Yes, significantly
Yes, slightly
No
Unknown
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5. Importance Ranking
3
(1 = Not urgent, 5 = Critical)
SECTION 3 — Financial Scope
1. Estimated Cost Range
Select an answer...
Under $1,000
$1,000–$5,000
$5,000–$15,000
$15,000–$50,000
$50,000+
Unknown (needs vendor quote)
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2. Vendor or Supplier (If Known)
3. Can the site operate without this improvement?
Select an answer...
Yes, with no issues
Yes, with reduced efficiency
Yes, but temporarily
No, site is compromised
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SECTION 4 — Approvals & Follow-Up
1. Recommendation from Regional Manager
Select an answer...
Approve
Defer
Not recommended
Needs further review
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2. Required Follow-Up Actions (Select all that apply)
Obtain vendor quote
Schedule site inspection
Temporary fix needed
Submit to Finance for budget approval
Submit to C-suite for final approval
No follow-up needed
3. Additional Notes or Justification
4. Follow-Up Deadline (Optional)
Submit Request
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Request saved successfully!
Capital Improvement Requests