Maintenance Work Order Form
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1Maintenance Work Order Form
Company: ____________________________________ Date: ____________ Work Order #: _________
Equipment Name: ______________________________ Requested by: ___________________________
Equipment ID: _____________________
Date/Time Submitted: ____________________
Work Order Type:
New or
Routine (check one)
PSM Process Area:
Yes or
No (check one)
Work Order Description: _________________________________________________________________
Work Order Submitted To: ___________________________________
Request Date for Work Completion: ________________
Above to be completed by person generating work order.
_________________________________________________________________________
Below to be reviewed Maintenance Supervisor.
*Management of Change = MOC
Note: (MOC Form Required)
Yes
No MOC #: ____________________
Work Order Approved By: _________________________/Completed By: __________________________
Completion Date/Time: _________________________ Completed as Requested:
Yes
No
Number of Maintenance Personnel Required: ______ Total Hours for Job: _______
Record Comments:
_____________________________________________________________________________________
_____________________________________________________________________________________
List any Parts Replaced:
_____________________________________________________________________________________
Supplier Used: ___________________________________
Work Order Cancelled by: ____________________________________
Reason for Cancellation:
_____________________________________________________________________________________
_____________________________________________________________________________________
Revised: October 1, 2013
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Parent category: Business