M67001-17-Q-0018_Attachment_3.pdf

M67001-17-Q-0018

Attachment 3

COMPANY NAME

S E R V I C E W O R K T I C K E T

TO BE FI LED IN BY GOVERNMENT PERSONNEL

INFORMATION REQUIRED FROM INDIVIDUAL AT MACHINE LOCATION

DATE: TIME: NAME & PHONE #:

BLDG. #: _

MACHINE ID #: DECK #: ·DESCRIPTION O F PROBLEM/MALFUNCTION:

Repairs Made/Parts Used:

TO BE FILLED IN BY CONTRACTOR

Parts Placed on Order: Yes No

STATUS CHECK FOR PARTS DELIVERY:

Date:

T I ime: _

No. Name of Person Making Check Date of Check Parts Delivery Date Est Repair Date

I.

2.

Printed Name and Signature of Mechanic Performing Repair:___________________________________________________________________

INDIVIDUAL AT MACHINE LOCATION TO COMPLETE THIS SECTION

Individual's Printed Name, Signature and Telephone #: _

Date/Tune Machine Repaired: _

TO BE FILLED IN BY GOVERNMENT PERSONNEL

Date Time Performance Starts: Date: _________ Time:

Date Time Completed Service Work Ticket Turned In: Date:__________ Time.

Service Ticket No.