Crane 2020_Attachment 4 - Work Certificate Inventory.pdf
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- W912PB20Q3036
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ATTACHMENT 4 - Work Certificate Inventory Record (Name Contractor)
INVENTORY RECORD
PREVENTIVE MAINTENANCE AND REPAIR OF: "TYPE OF EQUIPMENT"
INVENTORY NUMBER: COMMUNITY:
CLIN'S
CLIN No. Quantity Maintenance Frequency
CLIN No. Quantity Maintenance Frequency
A = Annual S = Semiannual Q = Quarterly M = Monthly
J = Bi-Monthly W = Weekly B = Bi-Weekly D = Daily
EQUIPMENT TYPE: LOCATION, BUILDING #:
MANUFACTURER SERIAL #:
YEAR OF MANUFACTURE:
MANUFACTURER & MODEL #:
YEAR OF INSTALLATION:
OTHER EQUIPMENT SPECIFICATION:
(List numbers of maintenance steps performed as descripted in SOW CLIN MAINTENANCE PERFORMED : and/or information on maintenance performed IAW manufacturer's manual)
REMARKS : (EQUIPMENT CONDITION REPORT)
Inventory Label attached: Yes No
DATE TECHNICIAN INVENTORY ACCEPTED
DATE
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