VISAYAS SLAKED LIME CORPORATION Taganito Special Economic Zone Brgy.

Taganito, 8410 Claver, Surigao del Norte

JOB REQUEST FORM

Job Order No. Location: Tag Number: Purpose:

Date:

Identified Problem/Description

Repair Classification Priority Identified Hazard Emergency Normal PPE's Required

*To be filled-up by Maintenance

Repair Started Date Time

Activities Performed

Repair Finished Date Time

Remarks

Prepared by: ___________________________ Operation Shift Foreman

Reviewed by: ________________________ Safety In-charge

Noted: _______________________ Maintenance Shift Foreman

VISAYAS SLAKED LIME CORPORATION Taganito Special Economic Zone y. Taganito, 8410 Claver, Surigao del Norte

JOB REQUEST FORM

Date & Time of Malfunction

Repair Classification Normal PPE's Required

*To be filled-up by Maintenance

Remarks

________________________ Safety In-charge

_______________________ Maintenance Shift Foreman