Sample Work Order Form
Note: this is a triplicate form
1st sheet is the User File copy
2nd sheet is the Maintenance Progress File copy
3rd sheet is the Equipment History File copy
SECTION A: To Be Completed By User
Equipment Type: Inventory Number:
Item Location:
Name of person making request: Date:
Description of Problem:
Troubleshooting performed (if relevant):
SECTION B: To Be Completed By Head Of Equipment Maintenance
Date request received: Work order number:
Priority of task (high/medium or low): Task allocated to:
SECTION C: To be completed by Maintenance Technician
Was item repaired? Yes No
If Yes, complete Maintenance Report Form. If No, state reason work not completed
Return Item to User. and
return Work Order Form to Head of
Equipment returned to: Equipment Maintenance for follow up
and
completion of Work Order (by assignin
Date returned: another technician or outsourcing):
Name of Maintenance Technician: Signature:
After corrective maintenance is completed the Work Order Form and Corrective
Maintenance Log Form should be filed together in the Equipment History File.