The document is a maintenance work order and request form that requires the originator to fill in details such as work type, scheduling, line status, and problem description. It includes sections for equipment details, spare parts, used tools, and signatures from the technician, supervisor, and originator for closure. Additionally, it has a priority check for safety with classifications such as high and normal.

1. Maintenance Work Order
Work Request “to be filled by Originator”
Work Type: (Breakdown BD, Corrective Maintenance CM, Projects)
Scheduling: (Planned / unplanned)
Line status: (Working / Stopped)
Shift:……… Originator:……….. Request dept:……… Date:…../…../…… Time:………
Cost Center:………… Location:………. Equipment name:……….. Equipment code:…………. Responsibility….
Problem description:……………………………………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………………………………………………………
Problem Code:………….
SupervisorMaintenanceTo be filled by theSection
PhaseWork Order Execution
TimeCodeTechnicians
1.
2.
3.
Equipment Downtime:…………………….
Used Spare Parts:
QuantityCodeSpare Parts description
Used Tools:
QCodeNameQCodeName
Notes:______________________________________________________
__________________________________________________________________
WO Closing”Signatures”
Technician:…………… Supervisor:…………….. Originator:……………
Failure Code:Failure Description:
Cause Code:Cause:
Action Code:Remedy:
Clarification at the back of the paper!
Priority Check: Safety
High
Normal