BLADE CONTROL RECORD

BLADE TYPE ISSUED

(AR, FP, SH, SC)

ISSUED BY

ISSUERS SIGNATURE

ISSUED TO
(NAME AND KNIFE ID. CODE)

DATE

TIME

RECEIVERS SIGNATURE

OLD BLADE RETURNED INTACT YES / NO

(IF NO COMPLETE REVERSE)

BLADE TYPE KEY = Auto !t"# R$t%!#t!&'$ (AR), Fo'(")* P$) (FP), S+$!t+ (SH), S#!',$' (SC) PAGE - OF 2

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BLADE CONTROL RECORD

ISSUERS SIGNATURE RECEIVERS SIGNATURE REASON FOR NON RETURN OF BLADE/RETURN OF A DAMAGED BLADE ACTION TAKEN DATE TIME

BLADE TYPE KEY = Auto !t"# R$t%!#t!&'$ (AR), Fo'(")* P$) (FP), S+$!t+ (SH), S#!',$' (SC) PAGE 2 OF 2

HD -..-/ R$0"1"o) I11u$ D!t$3 -4.52.55