Skid Steer Bucket Release Issue Report Form
Report and document issues related to skid steer bucket release for prompt maintenance and safety follow-up.
Date of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Equipment ID or Serial Number
*
Skid Steer Model
*
Please Select
Bobcat S650
Caterpillar 262D
John Deere 320G
Case SR210
New Holland L228
Other
Location of Incident
*
Operator Name
First Name
Last Name
Describe the Circumstances Leading to the Issue
*
Observed Symptoms of the Bucket Release Issue
*
Bucket will not detach
Bucket detaches unexpectedly
Release lever stuck
Hydraulic release malfunction
Warning light activated
Other
Was There Any Safety Impact?
*
No safety impact
Near miss (no injury)
Minor injury
Major injury
Property damage
Immediate Actions Taken
*
Equipment shut down
Area secured
Supervisor notified
Maintenance requested
Other
Follow-up or Maintenance Needed?
*
Yes, immediate repair needed
Yes, schedule for later
No further action required
Additional Comments or Details
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