Weekly/Monthly/Annually Preventative Maintenance Record

Electronic Department Written By: Signature:

Position: Date:

Who: Designated trained maintenance personnel When:

Weekly/Monthly/Annually
What: Record the week, the year and your name in the space provided
Record the date that the maintenance was conducted. Initial and write the time in the appropriate boxes. Describe
the deviation and corrective actions taken in the corresponding column.

Date : __________________ Year: ______________ Name of the maintenance’s technician:

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PREVENTATIVE MAINTENANCE

Maintenance Date Time Deviation Deviation Corrective Initials

Equipment –ID conducted Completed Yes/No Actions
number