ROUTING

MRD

SERVICE REPORT HMR

NG
1
DEALER WORK SEG. CUSTOMER
CODE ORDER NAME
EMPLOYEE EQUIPMENT
DATE
IDENTIFICATION LOCATION
CATERPILLAR CATERPILLAR INSTRUCTIONS:
MODEL SERIAL NO.

HOURS MILES KILOMETER

DID THIS INCIDENT

PART NUMBER PART DESC.* GROUP NUMBER DESCRIPTION COMMENTS
QTY. GROUP NAME MAKE THE PRODUCT
RESPONSIBLE NAME CODE CONTAINING PART INPROBABLE? (20 SPACES MAXIMUM PER INCIDENT)

YES NO

YES NO

YES NO
A - Structural C - Leaks E - System Malfunction G - General Repair K - Serviceability X - OPERATION
DESCRIPTION CODES * B - Surface D - Factory Assembly F - Factory Shipping H - Adjustment N - Abuse COMPLAINT
RELATED SERIAL NUMBER
COMPONENT ARRANGEMENT/ LABOR MAN
CATERPILLAR OEM PRODUCT DESCRIPTION
TEST/SERIAL NUMBERS CODE HOURS

MODEL SERIAL NO. MAKE/MODEL COMPONENT NUMBER

VEHICLE CONFIGURATION

DELIVERY DATE OF
DATE LAST LABOR
WHAT WAS THE
CUST OMERS’ COMPLAINT?

ADDITIONAL COMMENTS ON
THE CAUSE OF FAILURE?

WHAT WAS THE

RESULTANT DAMAGE?

HOW DID YOU

REPAIR IT?

CUSTOMER SERVICEMAN
SIGNATURE SIGNATURE

IF COPY OF THIS PAGE IS BEING SENT

TO CATERPILLAR, COMPLETE FOLLOWING DEALER STORE 21