Underground Maintenance Checklist Form
Please complete this checklist to record all underground maintenance tasks performed during your shift. Ensure all items are filled accurately before submitting.
Maintenance Location / Site
*
Date of Maintenance
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Maintenance
*
Hour Minutes
AM
PM
AM/PM Option
Type of Maintenance
*
Please Select
Scheduled
Unscheduled
Emergency
Preventive
Corrective
Tasks Performed (check all that apply)
*
Inspection
Cleaning
Repairs
Equipment Testing
System Calibration
Other
Equipment Used
*
Safety Checks Completed
*
Yes
No
Issues Found / Actions Required
Personnel Responsible
*
First Name
Last Name
Additional Comments
Submit Checklist
Should be Empty: