Document No. Revision No.

Reviewed by: Managing Director

F/OHS/008/021 00

EQUIPMENT QUARTERLY MAINTENANCE FORM

Equipment Name Serial no Working condition of equipment Physical condition All
(safety guards in place, insulated cords, accessories
plugs, cleanliness, deformities) (Batteries, manual,
chargers etc)

Actions arising:
Equipment Serial no. Action required Action reported to Date action closed Comments
name

Maintenance by: Date: ..........................

Signature: Next Inspection date:…………………….

Date reviewed: 05.05.2021 Next review date: 06.05.2021