Record of Maintenance

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Client Details:

• Client Name:

• Billing Address:
  Address

Site Details:

• Site Name:

• Site Address:
  Address

Job Details:

• Date of Inspection:

  Date

• Job Number:

• Purchase Order:

• Work Order Number:

• Contact:

• Phone:

Results:

• Units:

Unit

• Unit ID:

• Type:

  ABE

  BE

  CO2

  Water

  Portable Eyewash

• Size:

  Select 1 kg 1.5kg 2 kg 2.5 kg 3 kg 3.5kg 4 kg 4.5 kg 5 kg 5.5 kg 6 kg 6.5 kg 7 kg 7.5 kg 8 kg 8.5 kg 9 kg 9.5 kg

  • 1 kg
  • 1.5kg
  • 2 kg
  • 2.5 kg
  • 3 kg
  • 3.5kg
  • 4 kg
  • 4.5 kg
  • 5 kg
  • 5.5 kg
  • 6 kg
  • 6.5 kg
  • 7 kg
  • 7.5 kg
  • 8 kg
  • 8.5 kg
  • 9 kg
  • 9.5 kg

• Service Level:

  Level 1

  Level 2

  Recharge Required

  Condemned

• Next Pressure Test Due:

  Date

• Corrective Action?

  Yes

  No

  N/A

• Result:

  PASS

  FAIL

Labour spent on job

• Labour:

Person

• Person:

  Select Drew Murray Chris Berthun Dave Hudson James Owens Daniel Schepis Nathan McNulty Loi Riccati Matt Rowe Mick Hughes

  • Drew Murray
  • Chris Berthun
  • Dave Hudson
  • James Owens
  • Daniel Schepis
  • Nathan McNulty
  • Loi Riccati
  • Matt Rowe
  • Mick Hughes

• Hours spent:

• Total man hours spent on job:

Sign Off

• The technician states that they have completed the above works to the relevant Australian Standards.

• Technician:

  Sign

• The clients representative states that they are satisfied that the above works have been completed.

• Clients Representative:

  Sign