Equipment Damage Form

Equipment Service Form

Please fill out ALL portions of this form
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Project:
REPORT ALL EQUIPMENT DAMAGE TO YOUR SUPERVISOR
Name of Person Reporting

First NameLast Name
Crew
Phone Number (we will reach out if we need more details)
Please enter a valid phone number.Format: (000) 000-0000.
Equipment Type

Other
Equipment Number
Damage or Mechanical Issue?
Location/ Block Number
Detailed Description of the Issue
Take Photo
Issue Reported to your Supervisor?
LOCKOUT & TAGOUT

Remember to lock and/or tag out the equipment
Should be Empty:

Equipment Service Form