Equipment Request MACC_KARF_MS-09-01

Requestor
Name: Nader El Nadri Computer #: B00532 Site: Kaust
Service code: 0T21 PTW#: Work Order#: 185087742
Required Equipment: Compressor Jackhammer (with forklift and dyna to transfer it to location) Advise Required: Yes No
Location: P-7241
Required Date, From: 8:30AM To: 10:30 AM Day shift: ✔ Night Shift:

Requestor Signature: Nader El Nadri

_________________

Operator Required Yes No

* If no, then fill the Equipment hand over form Part A

R&F Maintenance Manager Approval

Name: Date: PTW #:
Justification:
Excavation to rectify the minor Water Leak Under ground

Person from the service to coordinate with:

Name: Mobile#:

R&F Maintenance Manager Signature:_________________

Equipment Department
Task type: Task status:
Request received advised by: Comp#: Contact#:
Operator Name: Comp#: Contact#:

Operator Signature: _________________

Assigned Equipment: Serial Plate #:

Date From: To:
Time From: To:
Km/ hrs. Out In:

Prior to work checklist list checked: Success Failed

Job Complete on: Checked by: Comp#:

Signature: _________________
If the operator is not provided by Equipment department then fill the Equipment hand over form Part (B)
Diesel consumed: Yes No if Yes: Quantity: ______Liters

Retained By: Maintenance Manager Retention Period: 6 Months

August 2017 Page 1 of 1 Ver: 1.0