Maintenance Report

• Conducted on

  Date

• Prepared by

Maintenance Report

Maintenance Issue

• Location and description:

• Image of affected area:

  Media

• Is this a hazard?

  No

  Yes

• Describe corrective action:

• Image of corrective action:

  Media

• Urgency assessment: (1 - cosmetic minor, 10 - hazard major/urgent)

• Note corrective action, if taken:

• Image of corrective action:

  Media

• Completed:

  Date

• Reporting person:

  Sign