Table of Contents
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Completion report
• Safety inspection for machine type 3592
• General safety inspection
• Maintenance agreement qualification (MAQ)
After you complete the inspection, make a photocopy of this form. Sign, date, and complete the copy, then
store it with the MAQ form.
____________________________
NAME
SAFETY HAZARDS
LIST ALL SAFETY HAZARDS.
1.
____________________________________________________________________
2.
____________________________________________________________________
3.
____________________________________________________________________
4.
____________________________________________________________________
5.
____________________________________________________________________
6.
____________________________________________________________________
7.
____________________________________________________________________
8.
____________________________________________________________________
9.
____________________________________________________________________
10. ____________________________________________________________________
Complete this report to finalize the safety inspection.
___________________
DATE
IF NONE, SAY NONE.
________________
SERIAL NUMBER
Safety and Inspection 161
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