Describe issue

Photo of issue
Sketch to better explain issue ( only if required)

What remedial action is in place?

Please action Work Request;
Work Request completed by - who from the location was present
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.