Title Page
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Date and Time
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Name of User
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Machine
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Serial No
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Brief Description of Fault
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Reported To
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Location
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Remedial Action (Note: equipment must be taken out of service until repair work is carried out.)
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None: (Call service engineer - attach copy of engineer’s report to this document.)
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In-House Repair (Record Details of Work and/or Parts Used)
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Date of Repair
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I confirm that this item is fit for use (Manager/Supervisor, etc Name and Signature)
