Please provide details of the Defect

Add Photos of Defect (if Applicable)

Is the item of plant safe to operate?

Confirm action taken? E.g. Who the defect was reported to and when?

Operator Signature

Confirm defect rectified

Fitter / Repairer Signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.