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Tool Repair / Service Request Form

Report a fault, request repair and track outcome

Company logo

PAGE 1 OF 2

Request Details

Date

Requested by

Department / team

Contact number

Tool Details

Tool description

Make / model

Asset ID / serial #

Location / site

Fault / Issue Description

When did fault occur?

Is tool safe to use?

Yes No

Has tool been tagged out?

Yes No

Priority

UrgentSafety risk

HighAffects production

MediumWorkaround available

LowScheduled maintenance

Attach photos of the fault here (tape printed photos or reference file names)

Tool Repair / Service Request - Page 2 of 2

Asset ID

Date

Requested by

Repair Assessment

Assessed by

Date assessed

Diagnosis

Parts & Cost Estimate

Parts required

Estimated cost

Est. completion

Repair approved by

Repair Outcome

Repair completed

Parts used

Total cost

Returned to service

Quality Check

#	Check	Y	N	N/A	Notes
1	Tool tested and operational after repair
2	Safety checks completed (guards, switches, cords)
3	Tool cleaned and labels/tags updated

Requester Acknowledgement

Signature

Print name

Date

Repair Technician Sign-off

Signature

Print name

Date

Supervisor Approval

Signature

Print name

Date