Title Page

  • Conducted on

  • Name of Item:

Continue to Page 2 and complete ALL information including photo

  • Home Location of item needing repair:

  • Repair Urgency

  • Does the entire Apparatus housing this equipment need to be placed Out Of Service?

  • Give a brief description of what needs to be repaired.

  • Upload Photo of the item

Place RED TAG on item to signify it is Out Of Service

  • Where was the item left?

Email this form to nafd62264@gmail.com AND nafd157@sbcglobal.net

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.