Title Page

  • Equipment Name

  • Serial number/ model /make

  • What is the classification of the activity performed?

  • If a contractor performed the maintenance, please provide their company name.

Safety

  • Before starting maintenance check machine is operational, by running systems

  • Check operation of all Emergency Stops

  • Check operation of all Safety Guards and condition

  • Check operation of all interlocking mechanisms

  • Isolate Supplies where applicable

  • POWER

  • WATER

  • HYDRAULICS

  • AIR

  • Lock out tag out applied ?

Maintenance Activity

  • What is the date and time of the maintenance or calibration activity performed?

  • What is the name of the person performing the maintenance or repair activity?

  • Please provide a brief description of the work performed during the maintenance or calibration activity.

  • Were any parts replaced during the maintenance or repair activity?

  • Please list:

  • Were any supplies used during the maintenance or repair activity?

  • please list:

  • Did the maintenance or repair activity include any equipment inspection or testing?

  • Please attach relevant checklist(s) or report(s)

  • Was there any deviations or issues identified during the inspection or testing?

  • Please detail:

  • Did the maintenance or repair activity result in any downtime for the equipment?

  • Please provide the duration of the downtime.

  • Were there any recommendations for future maintenance or calibration activities based on the results of the inspection or testing?

  • Please detail:

  • Are there any additional comments or observations you would like to include regarding the maintenance or calibration activity?

  • Please provide additional comments or observations:

  • Take or Attach Photos of Equipment

  • Validated by:

  • Next Maintenance Due on:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.