EMP Bentu Ltd

INTERNAL WORK REQUEST FOR PREVENTIVE MAINTENANCE

WO Number : :
Description of Request (filled by initiator)

Service / PM :

PM Date :
Location/Equipment Tag No. :
(filled by initiator)
Justification (filled by initiator)

Preventive Maintenance Schedule

Request status Accept Reject

Material / Part Required :
(filled by planner)
Estimated cost (USD) :
PM Duration (Hours) :
Executor :
Noted :

Expected Completion Date :

(filled by Maint Supt)
Actual Completion Date :
(filled by Maint Supv)

Requested By Approved By Executed By

Name : Name : Jony Ridas Name :

Date : Date : Date :
Maint. Supervisor Maint. Superintendent