Title Page
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Document No.
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PLEASE RECORD this NUMBER on the YELLOW DEFECT TAG that you have ATTACHED to the DEFECTIVE PIECE of EQUIPMENT
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PLEASE Specify EQUIPMENT TYPE
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Where has this Equipment come from ? Please specify Call sign, Registration or Location, where this not from a vehicle.
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Equipment Defective ON
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Location
EQUIPMENT DEFECT
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Equipment Serial Number :-
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What is wrong with the Equipment ?
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Please provide photos of the broken / defective equipment from 2 different angles
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Declared defective by : Name and PIN :-
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Did the equipment fail whilst in USE ?
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Please confirm the Incident report (IR1) number
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Has the equipment been cleaned and removed from service - With YELLOW Tag attached
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Defective Equipment reported to :-
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Please explain why not ?
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PLEASE GO THE END OF THE FORM AND PRESS "AUDIT COMPLETE" The next section is for the Supervisory team. Thank you.
SUPERVISOR
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Equipment Sent for repair ?
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Date Sent ?
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Address and Name of Person dealing at the Company where the equipment has been sent ?
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Confirmation that the equipment has been received by the Company / Person specified above.
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When was the defective equipment received ?
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IF the equipment was declared as being "Beyond Economical Repair" has it been disposed of?
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Please explain how the equipment was disposed of:-
RETURN TO SERVICE
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Equipment returned to service ?
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When ?
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Equipment Next Test Date ?
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EQUIPMENT ASSET REGISTER UPDATED ?
