Equipment Repair Report

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Equipment Details

• Make

• Model

• Serial number

• Description/type

• Registration or equipment number

• Kilometers or hour meter

Complaint

• Description or symptom of fault.

• Intermittent?

  Yes

  No

  N/A

Cause

• Describe suspected cause.

• Is it possibly caused by misuse or operator error?

  Yes

  No

  N/A

• Is it caused by impact damage?

  Yes

  No

  N/A

Action Taken

• Describe action taken to repair?

• Was this a temporary/emergency repair?

  Yes

  No

  N/A

Recommended Further Actions

• Describe any further actions recommended to repair.

• Describe suggested actions to prevent reoccurrence?

• Any other repairs required?

Equipment Condition

• Suggest to shutdown/tag out equipment?

  Not applicable

  Management to decide/action

  Definately

• What is the overall general condition of equipment?

  Satisfactory

  Good

  Poor

  Uneconomical to repair

• Details?

Sign Off

• I have carried out the above requested repair as per this report.

  Sign

• Customer representative confirmation print and sign name here.

  Sign