Vehicle/Equipment Repair and Maintenance Reporting

Please complete this form in its entirety. Your supervisor will reach out to you for further instructions if they have not yet been notified.

Employee Name(Required)

First Last

Date(Required)

MM slash DD slash YYYY

Vehicle/Equipment Status(Required)

Out of Service – Requires immediate repair (non-operational or safety hazard)

Moderate – In safe working order, but needs to be addressed

Preventative Maintenance Needed

Maintenance/Repairs Completed

Maintenance/Repairs Scheduled

Description of Maintenance/Repairs Needed(Required)

License Plate/VIN Plate/Serial Number Plate(Required)

Mileage or Hours Meter(Required)

Photo of Damage/Repair Needed(Required)

If damage or affected part is not visible, please submit a full body photo of vehicle/equipment.

Photo of Damage/Repair Needed

Action Taken(Required)

Repair Shop Details(Required)

Please include the shop Name, Phone number, and the type of repairs/maintenance to be completed.

In-House Repair/Maintenance Completed(Required)

Include type of maintenance/repair performed at CLS Shop or Jobsite.

Have repairs/maintenance been completed at this time?(Required)

Yes

Photo of Completed Maintenance/Repair(Required)

Photo of Completed Maintenance/Repair

Does the Vehicle/Equipment require any additional repairs?(Required)

Yes

Additional Repairs Needed(Required)

Is the Vehicle/Equipment in safe working order after repairs?(Required)

Yes

If no, please explain(Required)

Collins Land Services, LLC.

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