Breakdown/Work permit Slip Doc No: BS/PP/T06/v1

Section: Date: Shift: A Department Breakdown / Work Permit Slip No.:

Before Attending Breakdown During Breakdown

Breakdown Start Time : Job Start Time : Response Time (in minutes): 12:00:00 AM
Machine on which breakdown occurred (Machine No.): Reason for delays, if more than 20 minutes:

Problem Description:

Root cause of breakdown, if known:

After Attending Breakdown

Job End Time & Date : 0 Details of job done on the equipment : Spares used:

Equipment Handover Condition :

OK

Partially OK, to be attended within 24 hours

Partially OK, to be attended in next RM / PM

Not OK, to be attended by next shift

Remarks :

Signature of Production Staff Name/Signature of Maintenance Staff