SOP Ref.No.

:
Annexure -1
Equipment Breakdown Intimation cum Completion Slip –
Name of Equipment: _______________________ I.D No.: _______________
Area /Room No.: ________________________ Batch No.: _____________
product Name : _________________________ Stage : ________________
Breakdown Description :
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Initiated by (user Department ) :

Name : Sign.& Date : Time :

Evaluation by QA :
______________________________________________________________________________________________________
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______________________________________________________________________________________________________
______________________________________________________________________________________________________

Name : Sign. & Date : Time :

Received By (Engineering Department ) :

Name : sign . Date : Time :

Action taken by Engineering : ___________________________________________________________

______________________________________________________________________________________________________
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Types of Breakdown : (Tick whichever is applicable )

1. Mechanical 2. Electrical 3. IT 4. Operational 5. Utility

Spare consumed : (Write technical specification )
Sr.No. Faulty Spare –Technical specification New spare used –tech. spec

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Trial taken found satisfactory / Not satisfactory :
Comment (if any ) :
______________________________________________________________________________________________________
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Checked By user dept. :

Name : Sig. & date :

QA Clearance :

Cleaning Required :
Re-qualification Required
Machine released for production –

Comments (if any ) –

______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
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Approved by : Quality Assurance Department

Name : Sign. & Date :

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