Title Page

  • Site conducted

  • Full Name/Team/Contractor:

  • Date:

  • Prepared by:

  • Project Title:

  • ELR & Mileage:

Breakdown Details

  • Is this OTP?

  • Who is the POS provider?

  • Who is the plant Provider?

  • What is the type of plant?

  • Fleet No

  • What is the Fault?

  • Complete failure of Plant?

  • Plant unused?

  • Fitter attanded?

  • Repaired?

  • ALO?

  • How Long downtime?

  • Was recovery Required?

  • Did this cause a safety issue?

  • Any Further Comments?

Signature

Actions to be entered into CMO:

  • Enter an Action, an Action Owner, and an Action Date.
    If N/A, enter “No actions”.

  • 1.

  • 2.

  • 3.

  • 4.

  • 5.

  • 6.

  • 7.

  • 8.

  • All actions have been assigned correctly, and Close Calls recorded where required.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.