Equipment Damage Form

Equipment Service Form

Please fill out ALL portions of this form
Date*

MonthDayYear
Date
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*

BusCompany Truck/ RentalCrew VanDozerExcavatorFlat Bed/ GooseneckForkliftFront End LoaderGraderHydrovac TrailerPanther T8/ MurrkaPile DriverRollerSkid SteerTractorTrencherRough Terrain Vehicle RTVWater TruckOther
Equipment Number*
Damage or Mechanical Issue?*

DamageMechanical IssueBoth
Location/ Block Number*
Detailed Description of the Issue*
Take Photo
Issue Reported to your Supervisor?*

YESNO
LOCKOUT & TAGOUT

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

Equipment Service Form