WESTERN TANEY COUNTY FIRE

MAINTENANCE ACTION FORM

DATE:

 
EQUIPMENT:

 
MAINTENANCE REQUESTED BY:

 
DESCRIBE PROBLEM:____________________________________________________________________________
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ACTION TAKEN: ______________________________________________________________________
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PARTS USED:_________________________________________________________________________
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PARTS NEEDED:_______________________________________________________________________
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DATE PARTS ORDERED: AUTHORIZED BY:
COMPANY NAME:
AWAITING PARTS:                 YES                 NO EQUIPMENT OUT OF SERVICE:              YES            NO
WORK COMPLETED BY (PLEASE DATE):
CREW SIGNATURE: SHIFT SUPERVISOR SIGNATURE: