Corrective Maintenance Report form
Corrective Maintenance Report form
device:- Refrigeratormodel:
Name of device:-Refrigerator model:-V170KEserial:-
-RCW50serial:-
-TCW3000 serial:- 93400269361700
2330034
Name of device:-Refrigerator model: -v170KE serial:54800103
No:-Corrective
Inventory No:-EHC5Ward
EHC3 Ward
JHC05Ward Maintenance
name/installation
name/installation
name/installation Report
place:-Enango
place:-Jogir form
place:-EnangoHCRoom
HC Room
HC No,-
Room
No,-
Inventory No:-EHC4 Ward name/installation place:- Enango HC_Room
No,
Previous repaired date:-
Previous
Part
Name repaired
repaired
of device:- date:-
last time:-
Refrigerator/Freezer_model: HTCD-90
Previous repaired date:-
Part
Nowrepaired
failure last time:-
symptoms:-
-serial:
Part repaired last time:- not making cold
BEOG33GATOOQEP6K0009 normal temprature
Now failure
Inventory symptoms:-
No:- not making cold
Now failure
Action taken byDGR4
symptoms:- Ward
not name/installation
making
user:-_ nothing place:-Dongoro HC Room
normal (2-8)range
Action taken
Previous by user:-_
repaired nothing
date:- Nothing
Action
Task taken
allowed by user:-_
to(technician received task):- checking power heater
Task allowed
Part repairedto(technician received
last time:- received task):- checking power heater
Task allowed
Action to(technician
taken:-replacing power heatertask):- seeing its thermostat
Now failure symptoms:- Out
Action taken:-replacing power heater of range
Action taken:-Replacing its thermostat board
Action taken bySPARE user:-_ USED(ACCESSORY
Nothing AND OPTION)
SPARE
Task allowed to(technicianUSED(ACCESSORY AND
received task):- checking OPTION)
DCV power from
S/n Product
Product name(s)
SPARE
name(s)
USED(ACCESSORY AND OPTION)
Specification Quantity Remark
Remark
S/n Specification Quantity
S/nsolar panels
Product name(s) Specification Quantity Remark
S/n
1.
1. Product
Power
Power name(s)
Heater
heater Specification
120W
300W Quantity Remark
01
01
1. Action
Power taken:-checking
heater its connection 300W 01
1.
2. Thermostat board E70 01
IS SPARE USED(ACCESSORY
2. DEVICE MAINTAINED? __ YES AND OPTION) NO
IS DEVICE MAINTAINED? ------- YES NO
IS
If DEVICE
No Reason: MAINTAINED? __ YES NO
S/n Product- name(s) Specification Quantity Remark
If No
IS Reason:
DEVICE - MAINTAINED? __ YES NO
If
1.No Taken(Date(S)/Hour(S)):
Time Reason: - -2 hr
Time
If Taken(Date(S)/Hour(S)):
No Reason: - -2 hr
Time
2. Taken(Date(S)/Hour(S)):
NAME OFTECHNICIAN:-Lucha -2 hrMekonin SIGN____DATE _____22/12/24
NAME
Time OFTECHNICIAN:-Lucha
Taken(Date(S)/Hour(S)): Mekonin SIGN _________DATE ______19/12/24
-2 hrMekonin
NAME OFTECHNICIAN:-Lucha
NAME OFTECHNICIAN:-Keneni Zewude SIGN____ SIGN____DATE ______21/12/24
DATE_____22/12/24
IS
NAME
NAMEDEVICE MAINTAINED? Mekonin
OFTECHNICIAN:-Keneni Zewude __ SIGn___DATE
SIGN YES
____ ______20/12/24NO
DATE_____19/12/25
NAME OFTECHNICIAN:-Lucha
OFTECHNICIAN:-Keneni Zewude SIGN____ DATE_____21/12/24
If No Reason:
NAME -
OFTECHNICIAN:-Keneni Zewude SIGN____DATE_____20/12/24
Date
Timeof item returned to work: --223/12/24
Taken(Date(S)/Hour(S)): hr
Date of item returned to work: - 20/12/24
Date of item
Comment returned
of user to work: - 22/12/24
_exicited
NAME OFTECHNICIAN:-Lucha Mekonin SIGN____DATE _____23/12/24
Comment
Date ofofitem
userreturned
_exicitedto work: - 21/12/24
Comment of user _exicited
Name OFTECHNICIAN:-Keneni sign date
NAME Zewude SIGN____ DATE_____23/12/24
Name
Comment of user _exicited sign date
Name sign date
Name sign date
Date of item returned to work: - 24/12/24
Comment of user _exicited
Name sign date
Corrective Maintenance Report form
device:-Refrigerator
Name of device:- Refrigeratormodel:
model:-MK404
Refrigerator_model: 9370622
serial:-20130896507
-RCW50serial:-
-MK404serial:-20130379649
No:-Bila001_Ward
Inventory No:-BG01Ward name/installation
No:-DGR1Wardname/installation
name/installation place:-BIlaGambel
place:-Babo
place:-Dongoro HCHC
Room
HC No,-
Room
Roo
No,
Corrective
Previous repaired date:- Maintenance Report form
Part repaired last time:-
Now
Namefailure symptoms:- Temperature
not making
of device:-Refrigerator _model:cold
out of range
-RCw50KE_serial:- 9390922
Action taken
Inventory by user:-_ nothing
No:-_Gr001_Ward name/installation place:-Gori HC Room No,-
Previous
Task repaired
allowed date:- received task):- checking power supply,
to(technician heater
Part repairedboard,
Thermostat last time:-
and checking its relay, capacitor
Action taken:-replacing power heater
Now failure symptoms:- not making cold
Action taken:-replacing power heater
Action taken by user:-_ nothing
SPARE USED(ACCESSORY
Task allowed to(technician ANDpower
received task):- checking OPTION)heater
SPARE USED(ACCESSORY AND OPTION)
Action
S/n taken:-replacing
Product name(s) power heater
SPARE USED(ACCESSORY Specification
AND OPTION) Quantity Remark
S/n
1. Product
Power name(s)
heater Specification
120W Quantity Remark
01
S/n Product name(s)
SPARE USED(ACCESSORY AND OPTION) Quantity Remark
Specification
1.
2. Relay ¼ 01
1. Relay 1/4
S/n
2. Product name(s)
Capacitor Specification
80microfard Quantity Remark
01
IS
1. DEVICE MAINTAINED?
Power heater __ YES 120W NO 01
IS DEVICE MAINTAINED? __ YES NO
IS DEVICE MAINTAINED? __ YES NO
2.
If No Reason: -
If No Reason: -
If No Reason: -
Time Taken(Date(S)/Hour(S)): -2 hr
Time Taken(Date(S)/Hour(S)):
IS DEVICE MAINTAINED? -2 hr __ YES NO
Time Taken(Date(S)/Hour(S)): -2 hr
NAME OFTECHNICIAN:-Lucha Mekonin SIGN____DATE _____24/12/24
NAME OFTECHNICIAN:-Lucha
If No Reason: - Mekonin SIGN____DATE _____26/12/24
NAME OFTECHNICIAN:-Lucha Mekonin SIGN____DATE _____25/12/24
NAME OFTECHNICIAN:-Keneni Zewude SIGN____DATE_____24/12/24
NAME OFTECHNICIAN:-Keneni
Time Taken(Date(S)/Hour(S)): -2 hrZewude SIGN____DATE_____26/12/24
NAME OFTECHNICIAN:-Keneni Zewude SIGN____DATE_____25/12/24
NAME OFTECHNICIAN:-Lucha Mekonin SIGN____DATE _____27/12/24
Date
NAME of item returned to work: - 25/12/24
Date of OFTECHNICIAN:-Keneni Zewude SIGN____DATE_____27/12/24
item returned to work: - 27/12/24
Date of item returned to work: - 26/12/24
Comment of user _exicited
Comment of user _exicited
Comment of user _exicited
Name sign date
Name
Date of item returned to work: - 28/12/24 sign date
Name sign date
Comment of user _exicited
Name sign date
Corrective Maintenance Report form
Name of device:- Refrigeratormodel:
device:-Refrigerator -V110KEserial:- 9140539
model:-TCW3000serial:- 80600026
Inventory
Inventory No:-WRJ02Ward
No:-WRJ04Ward name/installation
name/installation place:-Wera
place:-Wera JIru HC Room
Jiru HC Room
Previous
Previous repaired Corrective
repaired date:-
date:- Maintenance Report form
Part
Part repaired
repaired last
last time:-
time:-
Now
Now failure symptoms:- not
Name failure
of symptoms:-
device:- out making
Refrigerator cold
model:
of range -V110KEserial:-80700062
Action
Action taken
Inventory by
by user:-_
user:-_ nothing
No:-Gr004Ward
taken name/installation place:-Gori HC Room No,-
nothing
Previous
Task
Task repaired
allowed
allowed date:- received
to(technician
to(technician received task):-
task):- checking
checking power
power heater
supply,
Part repaired
Thermostat last time:-
board, and checking its relay, capacitor
Action taken:-replacing power heater
Now failure symptoms:- not making cold
Action Corrective Maintenance Report form
Action taken:-replacing power
taken by user:-_ nothing heater
Task allowed
Name SPARE USED(ACCESSORY
to(technician
of device:-Refrigerator received
model:task):-
-TCW3000 AND
checking OPTION)
power
-serial:- heater
9150592
SPARE USED(ACCESSORY AND OPTION)
Inventory
Action
S/n No:-KK2Ward
taken:-replacing
Product name(s) name/installation
power heater place:-Kiltu Kera HC Quantity
Specification Room NRemark
S/n Product name(s)
Previous repaired date:- Specification Quantity Remark
1. Capacitor 80microfarad 1
Part Power
1. repaired
heaterlast time:- USED(ACCESSORY
SPARE 175WAND OPTION) 01
2. Relay
Now failure symptoms:- out of range 1/4 1
S/n Product name(s) Specification Quantity Remark
Action
IS DEVICE taken by user:-_ nothing __ YES
MAINTAINED? NO
IS
1. DEVICE MAINTAINED?
Power heater __ YES
175W 01 NO
Task allowed to(technician received task):- checking
If No Reason: -
power supply,
Thermostat
2.No Reason: - board, and checking its relay, capacitor
If
Time Taken(Date(S)/Hour(S)): -2 hr
Action
Time taken:-replacing-2power
Taken(Date(S)/Hour(S)): hr heater
IS
NAMEDEVICE MAINTAINED? Mekonin
OFTECHNICIAN:-Lucha __ SIGN____DATE
YES _____28/12/24NO
NAME OFTECHNICIAN:-Lucha Mekonin SIGN____DATE _____27/12/24
If No Reason:
NAME -
OFTECHNICIAN:-Keneni Zewude SIGN____DATE_____28/12/24
NAME OFTECHNICIAN:-Keneni Zewude SIGN____DATE_____27/12/24
SPARE USED(ACCESSORY AND OPTION)
Time Taken(Date(S)/Hour(S)): -2 hr
S/n Product name(s) Specification
NAME OFTECHNICIAN:-Lucha Mekonin SIGN____DATE _____27/12/24
Quantity Remark
Date of item returned
boardto work: - 29/12/24
1. of
Date Thermostat
item returned to work: - 28/12/24 E70 01
NAME OFTECHNICIAN:-Keneni Zewude SIGN____DATE_____27/12/24
Comment
2. of user _exicited
Comment of user _exicited
Name sign date
Name
IS DEVICE MAINTAINED? sign
__ YES date NO
Date of item returned to work: - 28/12/24
If No Reason: -
Comment of user _exicited
Time Taken(Date(S)/Hour(S)): -2 hr
Name sign date
NAME OFTECHNICIAN:-Lucha Mekonin SIGN____DATE _____28/12/24
NAME OFTECHNICIAN:-Keneni Zewude SIGN____DATE_____28/12/24
Date of item returned to work: - 29/12/24
Comment of user _exicited
Name sign date
Corrective Maintenance Report form
Name of device:-Solar
device:- Refrigerator
device:-Refrigerator
SDD refrigerator-model:-HTC-40
model:
model:-TCW3000 serial:- 9381328
- V170-serial:-60300018
Inventory No:- YB0002 Ward name/installation place:- Yubdo HC-Room
serial:BEOG34GATOOQEHBJ0067
Previous repaired
Inventory No:-AY01Ward
No:-AYWK1 date:- Ward
name/installation place:-Ayira
name/installation place:- HC Room
Ayira No,-
Room No,-
Part repaired
Previous last time:-
repaired date:-
Now
Part repaired last time:- out Maintenance
Corrective
failure symptoms:- of range Report form
Action
Now takensymptoms:-
failure by user:-_ Temprature
nothing
out of range Out of range/damaged by armed
Name
Action of device:- SDD refrigerator/freezer_model:
taken to(technician
by user:-_ nothing -VC150sdd
forces
Task allowed received task):- checking power heater
serial:-WP1731-036
Action taken to(technician
by user:-_ received Nothing
Task allowed
Action taken:-replacing task):- checking power supply,
Inventory No:-GL2 Wardpower heater
name/installation place:-Gulliso HC Room No,-
Thermostat
Task allowed board, and checking
to(technician receiveditstask):-
relay,checking
capacitorDCV power from
Previous repaired date:-
solar
Action
Part panels, checking
last time:-physical
taken:-replacing
repaired damage
power heater
Action
Now taken:-
failure checking its connection(new
SPARE USED(ACCESSORY
symptoms:- Temperature Out ofinstallation/connection
AND OPTION)
range of
its wire)taken bySPARE
Action user:-_ USED(ACCESSORY
Nothing AND OPTION)
S/n Product name(s) Specification Quantity Remark
Task
S/n allowed SPARE USED(ACCESSORY AND
to(technician received task):- checking
Product name(s) OPTION)
DCV power Quantity
Specification from Remark
1. Power heater 3000w 01
solar
1. panels, checking physical damage
S/n Capacitor
Product name(s) 80microfarad
Specification 1Quantity Remark
2.
Action
2. taken:- repairing its electrical board¼
Realy 1
1.
IS
2. DEVICE MAINTAINED? __ YES
SPARE USED(ACCESSORY NO
AND OPTION)
IS DEVICE MAINTAINED? __ YES NO
If No Reason: -
S/n Product name(s) Specification Quantity Remark
IS DEVICE
If No Reason: MAINTAINED?
- __ YES NO
Time
1. Taken(Date(S)/Hour(S)): -2 hr
Time
If No Taken(Date(S)/Hour(S)):
Reason: - -2 hr
NAME
2. OFTECHNICIAN:-Lucha Mekonin SIGN____DATE _____29/12/24
NAME
Time OFTECHNICIAN:-Lucha
Taken(Date(S)/Hour(S)): Mekonin SIGN____DATE _____29/12/24
-4 hr
NAME OFTECHNICIAN:-Keneni Zewude SIGN____DATE_____29/12/24
IS
NAME OFTECHNICIAN:-Keneni
DEVICE MAINTAINED? Mekonin
OFTECHNICIAN:-Lucha Zewude__SIGN____
YES DATE_____29/12/24
SIGN____DATE _____29/12/24NO
NAME
If OFTECHNICIAN:-Keneni
No Reason: - Zewude SIGN____DATE_____29/12/24
Date of item returned to work: - 30/12/24
Time Taken(Date(S)/Hour(S)):
Date of item returned to work: --430/12/24
hr
Comment of user _exicited
Comment
NAME
Date of OFTECHNICIAN:-Lucha
of user
item _exicited
returned Mekonin SIGN____DATE _____30/12/24
to work: - 30/12/24
Name sign date
NAME
Name OFTECHNICIAN:-Keneni
Comment of user _exicited Zewude SIGN____
sign DATE_____30/12/24
date
Name sign date
Date of item returned to work: - 1/12/24
Comment of user _exicited
Name sign date
Corrective Maintenance Report form
Name of device:-Refrigerato
device:-Refrigeratorr model:
model: -RCW50KE
-TCW3000serial:-1061908
-MK404serial:-2074515730
serial:-9390927
Inventory No:-
No:-GL1Ward
No:-HR0002Ward
CG03Ward name/installation
name/installation
name/installation
place:-Gulliso
place:-Chonge
place:-Haru
Room
HC
HCRoom
No,-
RoomNo,-
N
Previous repaired date:-
Part repaired last time:-
Now failure symptoms:- Temperature
No
outpower
of range
supply
out entering
of range the refrigerator
Corrective
Action taken by Maintenance
user:-_ nothing Nothing Report form
Task allowed to(technician received task):-Checking
task):- checking power
task):-measuring the power
supply,
heater
supply
Name of
Thermostat
of the walldevice:-Refrigeratormodel:
and
board,
correcting
and checking
power -RCW50KE
cable
its relay, serial:-
capacitor 9360943
Action taken:-Replacing burnt power heater
Inventory No:- CG04Ward name/installation place:-Chonge HC Room N
Action taken:-correcting
taken:-replacing power
powerheater
cables that damaged by rat
Previous repaired date:-
SPARE USED(ACCESSORY AND OPTION)
Part repaired last time:-
SPARE USED(ACCESSORY AND OPTION)
Now
S/n failure
Product symptoms:-
name(s) Temperature out of Specification
range Quantity Remark
Action
S/n
1. taken
Product
Power by user:-_
name(s)
heater Nothing 3000wSpecification Quantity Remark
01
Task
1. allowed to(technician received task):-Checking
2. Relay ¼ power heater
1
Action taken:-Replacing burnt power heater
2.
IS DEVICE MAINTAINED? __ YES NO
SPARE USED(ACCESSORY
IS DEVICE MAINTAINED? __ YES AND OPTION)
NO
If No Reason: -
S/n
If Product- name(s)
No Reason: Specification Quantity Remark
Time Taken(Date(S)/Hour(S)): - 3 hr
1. Taken(Date(S)/Hour(S)):
Time Power heater - 3 hr 3000w 01
NAME OFTECHNICIAN:-Lucha Mekonin SIGN____DATE _____1/1/25
2.
NAME OFTECHNICIAN:-Lucha Mekonin SIGN____DATE _____31/12/24
_____30/12/24
NAME OFTECHNICIAN:-Keneni Zewude SIGN____DATE_____1/1/25
NAME OFTECHNICIAN:-Keneni Zewude SIGN____DATE_____31/12/24
DATE_____30/12/24
IS DEVICE MAINTAINED? __ YES NO
If Noof
Date Reason: -
item returned to work: - 1/1/25
Date
Time of item returned to work: -- 1/12/25
Taken(Date(S)/Hour(S)): 31/12/24
3 hr
Comment of user _exicited
Comment
NAME of user _exicited
Name OFTECHNICIAN:-Lucha Mekonin SIGN____DATE
sign _____1/1/25
date
Name sign
NAME OFTECHNICIAN:-Keneni Zewude SIGN____ date
DATE_____1/1/25
Date of item returned to work: - 1/1/25
Comment of user _exicited
Name sign date
Corrective Maintenance Report form
Name of device:-Refrigerator-model: -V110KEserial:-72200065
-RCW50KE serial:-9130227
Inventory No:-NK002Ward
No:-SN02Ward name/installation
name/installationplace:-
place:-Nole
Seyo Nole
KebaHC HCRoom
RoomNN
Previous repaired date:-
Part repaired last time:-
Now failure symptoms:- Temperature out of range
Action taken by user:-_ Nothing
Task allowed to(technician received task):-Checking power heater
Action taken:-Replacing burnt power heater
SPARE USED(ACCESSORY AND OPTION)
S/n Product name(s) Specification Quantity Remark
1. Power heater 3000w
175w 01
2.
IS DEVICE MAINTAINED? __ YES NO
If No Reason: -
Time Taken(Date(S)/Hour(S)): - 3 hr
NAME OFTECHNICIAN:-Lucha Mekonin SIGN____DATE _____1/1/25
_____3/1/25
NAME OFTECHNICIAN:-Keneni Zewude SIGN____DATE_____1/1/25
DATE_____3/1/25
Date of item returned to work: - 1/1/25
4/1/25
Comment of user _exicited
Name sign date
Corrective Maintenance Report form
Name
Name of of device:-Solar SDD refrigerator
device:-Refrigerator_model:
device:-Refrigerator -model:-HTCD-90
-TCW3000
model: -V110KEserial: serial:- 9140572
-74900065
serial: BEOG33GATOOQNAA0047
Inventory
Inventory No:-CG02Ward
No:-NK003Wardname/installation
name/installationplace:-CHonge
place:-Nole KebaHCRoom No,-
HC Room
Inventory
Previous No:-NK0001
Previous repaired
repaired date:- Ward name/installation place:- Nole Keba HC
date:-
Room
Part No,- last
Part repaired
repaired last time:-
time:-
Previous
Now repaired
failure date:- Temperature
symptoms:-
Now failure symptoms:- Temperature outout of
of range
range
Part repaired
Action taken last
by time:-
user:-_
Action taken by user:-_ nothing Nothing
Now
Task failure
allowed symptoms:-
to(technicianTemperature
received Outchecking
task):- of range.power supply,
Task allowed to(technician
Action taken by user:-_ received task):-Checking
Nothing power heater
Thermostat board, and checking its relay, capacitor
Action
Task taken:-Replacing
allowed to(technicianburnt power
received heater
task):- checking DCV power of
Action taken:-replacing power heater
solar panels, checking physical damage
SPARE USED(ACCESSORY AND OPTION)
Action taken:- checking its connection(new installation/connection
SPARE USED(ACCESSORY AND OPTION) of
S/n Product
its wire) name(s) Specification Quantity Remark
S/n Product name(s) Specification Quantity Remark
1. Power heater SPARE USED(ACCESSORY
175wAND OPTION) 01
1. Relay ¼ 01
2.
S/n Power
Product name(s) Specification Quantity Remark
2. cable of 3m 2.5A 01
1. Fuse 16A 02 Its spare
IS DEVICE MAINTAINED? __ YES NO
IS
2. DEVICE MAINTAINED? __ YES NO
If No Reason: -
If No Reason: -
Time Taken(Date(S)/Hour(S)):
IS DEVICE MAINTAINED? - 3 hr __ YES NO
Time Taken(Date(S)/Hour(S)): - 3 hr
NAME OFTECHNICIAN:-Lucha
If No Reason: - Mekonin SIGN____DATE _____2/1/25
NAME OFTECHNICIAN:-Lucha Mekonin SIGN____DATE _____30/12/25
NAME OFTECHNICIAN:-Keneni
Time Taken(Date(S)/Hour(S)): -4 hrZewude SIGN____DATE_____2/1/25
NAME OFTECHNICIAN:-Keneni Zewude SIGN____DATE_____30/12/25
NAME OFTECHNICIAN:-Lucha Mekonin SIGN____DATE _____2/1/25
Date
NAME of OFTECHNICIAN:-Keneni
item returned to work: - 2/1/25
Zewude SIGN____DATE_____2/1/25
Date of item returned to work: - 31/12/25
Comment of user _exicited
Comment of user _exicited
Name
Date of item returned to work: - 2/1/25 sign date
Name sign date
Comment of user _exicited
Name sign date
