Title Page

  • Conducted on

  • Prepared by

  • Location
  • Deaprtment

  • This form is to be used for the reporting of faults found with machinery or equipment. Any faulty equipment or machinery must be isolated from its power source, marked up as unsafe to use and your direct line / department manager informed.

  • Description of Machine / Equipment

  • Photos of the Machine / Equipment

  • Machine / Equipment Serial Number

  • Location of machine / equipment - Building, department, bay location, etc

  • Description of fault found

For Use by Maintenance Department

  • Have repairs been made in-house?

  • Description of repairs required to be carried out

  • Is an external company / engineer required to make repairs?

  • Name of external company to be used for repairs

  • Has equipment been sent off site for repair?

  • Date equipment sent off site for repair?

  • Expected date for machine / equipment handback to production?

Equipment Hand Back

  • Have repairs been made to the machine / equipment?

  • What repairs have been carried out?

  • Date of department hand back

  • I confirm the equipment is safe and fir for use

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