Preventive Maintenance Form

Check below for New or Change of PM. If Change of PM indicate changes and reason for changes in the miscellaneous information area: NEW CHANGE (Does not exist in FAMIS) (Changes to already existing PM in FAMIS) Preventive Maintenance Information PM No. Description Superseded By Description PM Group Description Status (Choose One) ACTIVE Active Inactive Asset Type (Choose One) EQUIPMENT Equipment Facility Category/Type (Choose One) PREVENTIVE Preventive Predictive Inspection Priority (Choose One) LOW Emergency (1) High (2) Medium (3) Low (4) (4) Crew Size Craft Estimated Hours Schedule Information Frequency (Ex. Annual, Monthly, Weekly, etc.) Schedule Date Season Start Date Season End Date Miscellaneous Information Include any information you want about the PM such as parts/tools, readings, notes, comments, etc. If a change to a PM, indicate changes and reasons for change.

Tasks

Name of Data Collector Supervisor and Director Signature required for all PMs Supervisor Signature Director Signature Funding (Facility Only) Departmental Signature approves depletion of funds for repairs above. Fund/Dept./Account Authorized Signature

R:\new EQ PM\NDSCS\PM\NEW PM FORM.docx