Corrective Maintenance Record Work Order # ______________________ Date Issued _____________ Issue to be resolved: (e.g., orifice plate is loose and bent) The issue was from Corresponding Checklist No. ________, Component No. (e.g., E Outlet), Inspection Item No. (e.g., 2, 3) . – Required Actions Date Actions Planned Date Completed New bolts to fix the orifice plate Repair/replace the trash rack Restabilize side slope (indicate location) Repair riprap apron with 100 cubic yards of aggregate Revegetate (If there are additional tasks, list them here.) Responsible person(s): ______________________________________________________________ Special requirements Time of the season or weather condition:_________________________ Tools/equipment:____________________________________________ Subcontractor (name or specific type):___________________________ Approved by ___________________/_______________ Date _____________ (name/signature) Verification of completion by ____________/________ Date _____________ (name/signature) File this Corrective Maintenance Record in the Maintenance Log after performing maintenance
Corrective Maintenance Record Work Order # ______________________ Date Issued _____________ Issue to be resolved: (e.g., orifice plate is loose and bent) The issue was from Corresponding Checklist No. ________, Component No. (e.g., E – Outlet), Inspection Item No. (e.g., 2, 3) . Required Actions Actions Planned Date Date Completed New bolts to fix the orifice plate Repair/replace the trash rack Restabilize side slope (indicate location) Repair riprap apron with 100 cubic yards of aggregate Revegetate (If there are additional tasks, list them here.) Responsible person(s): ______________________________________________________________ Special requirements Time of the season or weather condition:_________________________ Tools/equipment:____________________________________________ Subcontractor (name or specific type):___________________________ Approved by ___________________/_______________ Date _____________ (name/signature) Verification of completion by ____________/________ Date _____________ (name/signature) File this Corrective Maintenance Record in the Maintenance Log after performing maintenance