Title Page

  • Request for repair

  • Foreman

  • Conducted on

  • Prepared by

  • Location
  • Equipment or tool #
  • Equipment or tool not listed. Add below.

  • Severity of the issue

  • Is anything leaking on the ground?

  • Is a spill kit needed?

  • Is a spill kit available?

  • Is the equipment or tool still usable?

  • Will this cause down time?

  • Please add photos of the issue

  • Please write a short description of the issue

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.