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PLANT, EQUIPMENT & MACHINERY MAINTENANCE RECORD Form PEMR

Use this form to specify and record periodic inspection and maintenance of individual plant, equipment and machinery. See Guidance Notes 4-11 – The Safe
Use of Machinery for additional information.

Description of Plant, Equipment or Machine: Serial No.:


Manufacturer:

Planned Maintenance Schedule and Additional Comments:

DATE DESCRIPTION OF MAINTENANCE COMMENTS COMPLETED BY

© - Peninsula v3 Form PEMR - Plant, Equipment & Machinery Maintenance Record - Page 1 of 2
DATE DESCRIPTION OF MAINTENANCE COMMENTS COMPLETED BY

© - Peninsula v3 Form PEMR - Plant, Equipment & Machinery Maintenance Record - Page 2 of 2

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