Describe what is wrong with the equipment:
Touch here to describe problem:
How was the equipment being used at the time?
Describe how it was being used at the time:
Was this the proper equipment for this work?
Have you had the same problem before?
If yes, provide additional detail:
Enter any pertinent information not covered above:
Include pictures of problem if applicable: select yes, then click on media to add pictures.
JCC Equipment Repair Request
Report of Needed Equipment Repair
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended
take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or
or other applicable laws. You should also seek your own professional advice to determine if the use of such
permissible in your workplace or jurisdiction.