JCC Equipment Repair Request

• Directions:

• To be completed by the operator and supervisor together.

• Email completed form to equipment@jcc-ri.com

• Conducted on

  Date

• Jobsite Name/Number

• Equipment Number:

• Repair Order Number:

• Location
  Address

Describe what is wrong with the equipment:

• Touch here to describe problem:

• How was the equipment being used at the time?

  Light

  Normal

  Heavy

• Describe how it was being used at the time:

• Was this the proper equipment for this work?

  YES

  NO

  N/A

• Explain:

• Have you had the same problem before?

  YES

  NO

  N/A

• If yes, provide additional detail:

Notes:

• Enter any pertinent information not covered above:

• Include pictures of problem if applicable: select yes, then click on media to add pictures.

  YES

  NO

  N/A

Sign Off

• Supervisor/Foreman

  Sign

• Operator

  Sign