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SERVICE REQUEST (SR) FORM

Fill by Requester
/ / Requestor Sign :
Date Of Service Request :
Bicycle Plate Number :
Section/Department : /
Requestor Name/ID :
SM Requestor sign :
Description of Service Request :

Name & Sign

Received Sign :
Fill By GA
Date SR Received : / /
SR Registerd Number :
SR Received by :
Fill by Bicycle Maintenance Coordinator (GA)
Item to be check & repair (Please Tick √): Result of Maintenance
General Appearance Handle bar grips
Reflectors, all sides Frame condition
Tires; tread & inflation Pedals & crank
Fenders & chain guard Chain condition
Seat, condition & height Brake operation
Wheels, spokes & alignment Kickstand
Baskets (Opt.) Lubrication
Handle Bars tight & level Painting

Repair Completed Date : / /


Repair by :
Check by :
Attachment 3 Page 1 of 1
Procedure No. F2820-P0002-04

F2820-F0135-00

BICYCLE SERVICE REQUEST


Fill by Requester
/ / Requestor Sign :
Date Of Service Request :
Bicycle Plate Number :
Name/ID No.
Section/Department : /
Requestor Name/ID :
SM Requestor sign :
Description of Service Request :

Name

Date

Fill By GA
/ / Received Sign :
Date BSR Received :
BSR Registerd Number :
BSR Received by : /

Fill by Bicycle Maintenance Coordinator (BMC)


Item to be check & repair :
General Appearance Handle bar grips Result of Maintenance :
Reflectors, all sides Frame condition
Tires; tread & inflation Pedals & crank
Fenders & chain guard Chain condition
Seat, condition & height Brake operation
Wheels, spokes & alignment Kickstand
Baskets (Opt.) Lubrication
Handle Bars tight & level Painting
Repair Completed Date BMC GAD Requestor
/ /
Repair by :

Name & Sign Name & Sign Name & Sign

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