A maintenance work order form to be used in maintenance planned & scheduled activities.

1. Planned Maintenance WO
Data Filled by the Planner
Priority:___Safety Work Type: PM/ PdM
___High PM Type/ Code: (Planned/ Inspection/ Routine)
___Medium PM Level: (Annual/ Semi Annual/ Quarter/ Weekly/ Daily)
___Low
Cost Center:………………. Shift…………. Equipment Name:…………….
Equipment Code……………… Location:………….. Required Time:………….. Date Required:……………..
Man Hr Required:…………….. Required Labors:…………. Responsibility:………….
TimeCodeTechnicians
1.
2.
Planned Tools:
QuantityCodeName
Planned Spare Parts:
QuantityCodeDescription
1.
2.
3.
Actual Used Spare Parts:
QuantityCodeDescription
1.
2.
3.
PM Steps:
Equipment running √ or XDone √ or XSteps / procedures
1.
2.
3.
4.
5.
6.
Execution Phase & Signatures
Total Actual Time:………. Date:………..
Technician Sign:……… Maintenance Supervisor Sign:………………. Planner Approval:………………