UF - Y - Repair Form

• Conducted on

  Date

• Prepared by

Item

• Item of Machinery

• Serial No.

• Date

  Date

• Hours

• Serviced/Checked By

Details

• Damage Done

• Possible Cause

• Action Taken

• Cost

Check

• Visual Inspection & Operation Check

  Yes

  No

  N/A

• Safety Check

  Yes

  No

  N/A

Complete

• Signature

  Sign