Vehicle/Equipment Repair and Maintenance Notification

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)

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

Description of Issue or Maintenance 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)

Details

Please include name/phone number of repair shop where vehicle/equipment was sent.

Collins Land Services, Inc.