Title Page

  • Conducted on

  • Prepared by

  • Site Name

  • E maintenance/City ref: ( Job number )

Type of condemned equipment

  • Make

  • Model

  • Serial Number

  • Please provide reason for condemnation ( Give as much detail as possible.)

  • Please provide photo's including serial number.

  • Do you have any comments or recommendations?

MANAGER COMMENTS (to enter notes and pictures, select the space under the option to open up the fields)

  • Confirm you have spoken to the manager (or their deputy) and agreed a course of action

  • Add here comments from the manager (or their deputy)

SIGNATURES

  • Signature of Tech:

  • Signature of the Site Manager (deputy):

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