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BREAKDOWN / REPAIR REPORT FORM

Property ID Number Equipment Code


Property Name Name of the Equipment
Location Equipment Location
Trouble Symptoms

Noticeable trouble symptoms description

Reported By: Reported to:


(Reporting Personnel with signature) Immediate supervisor with signature

Date: Reporting date Date: date received by supervisor

Assigned to:
Technician In charge (Technicians Signature)
Technician Date received assignement
Initial Findings:

Descriptive technician’s Findings

Subsequent Action Taken: Recommendation:

Descriptive Technician’s Action/s Technicians recommended action

Reported To:
Immediate Supervisor
Date: (date reported ti supervisor)

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