Site Maintenance form

Use this form to record the regular, perhaps urgent maintenance requirements within a BOORN location. Usure that anything urgent or a supervisor needs to be advised, act accordingly.

Location *

Mandurah Port Kennedy BunburyOther

Status *

General maintenance – Day to Day usage and fix up Needs to be looked at by someone more qualified – It is safe currently We need urgent maintenance – Lives can be at risk ( CONTACT YOUR MANAGER ASAP - Ensure safety practices) This is following an Incident or complaint Not working at all Unsure Other

Date

Who has requested this *

General on the Day Staff MemberSupervisor Senior Managment Parent - Customer Not applicable Other

Team Member Name

Supervisor Name

Team members email

Supervisor Email

Other team members Customers involved

Before

Before Photo 1: *

Browse

Before Photo 2: *

Browse

Before Photo 3:

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Before Photo 4:

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Description: *

Main Maintenace points - Comments

Action required.

After

After Photo 1: *

Browse

After Photo 2: *

Browse

After Photo 3:

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After Photo 4:

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Action and task completed

Further action *

No Action - All fixed Training required.Notify senior Management.Need to seek a professionalClosed the zone down Complete report for feedback, Complaint, incident or other Nothing required. Extra support required. I have requested a meeting. Other

I agree I have addressed the situation to the best I could *

Yes No

Comments

Signature

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Date of report

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