BREAKDOWN/FAULT REPORT

Date and Start Time:

Completion Time

Equipment Name: (Also select the equipment Under Asset)

Operator:

Shift:

Run hour for Machine with Fault (Leave blank if machine has no Meter)

Meter name

Downtime (min)

Fault Description/Symtoms/Problem Summary:

Photo of Fault (where applicable)

State the Issue reported by Production:

RESULTS OF FAILURE:

• Plant Shutdown

• Personal Injury/Safety

• Quality Issues (package off spec)

• Product Spill

• Process Shutdown

• Environmental Issues

• Quality Issues (product off spec)

Repair Description/Diagnostic steps performed (to include troubleshooting steps):

Corrective Actions performed:

Root Cause (Ask yourself the 5WHY’s):

Recommendations (failure prevention & long-term action):

Permanent fix to Fault? Any Repair that requires follow up Please mark Fail and add a comment.

• Pass
• Flag
• Fail

DONE BY: SIGNATURE

DONE BY: SIGNATURE