Hydraulic Breakdown Report Form
Please complete all sections to report a hydraulic equipment failure for maintenance review.
Reporter Name
*
First Name
Last Name
Equipment ID or Serial Number
*
Incident Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Incident Location
*
Machine Type
*
Please Select
Excavator
Loader
Bulldozer
Backhoe
Crane
Forklift
Other
Breakdown Description
*
Severity of Breakdown
*
Minor (machine still operable)
Moderate (limited operation)
Major (machine inoperable)
Operating Conditions at Time of Failure
*
Normal operation
High load
Extreme temperature
Continuous use
Other
Immediate Actions Taken
*
Parts or Repairs Needed
*
Submit Report
Should be Empty: