Maintenance Work Order (W O) Description Include Date

W O No.

Completion Priority

 

SH &E

Completion Priority

Ops Production

Completion Priority

 

Quality

W O Requested Due To

Incident   A.

Accident (injury)     B.

Damage Vs.

Normal Wear & Tear   C.

(notate cause A. B. or C. in your description below.)

Estimate Damage and/or

Down Time Cost $

 

 

1

2

3

 

1

2

3

 

1

2

3

 

 

Repair damage to bottom plate of pit recuperator and repair or replace severely damaged top casting tubes. 01 04 20xx

 

 

 

 

 

 

                S A M P L E 
F O R M

 04678

 1. High-

 Potential

 Near Miss W/

 Damage

 Investigation 

 Ongoing

 1

No other recuperator in storage for use at this time

           2

 C. Damage to uninsured equipment,  

       Not Normal Wear.

A six ton metal recuperator was being lifted by an overhead crane onto a low boy truck for use in operations in another facilities pit ops. During the lift a 1/2 inch cable separated from the bridle, causing the recuperator to fall from an elevation of three feet onto the concrete floor below.

Damage to the recuperator bottom plate, tubes, and cable are estimated at $34,000. The Rigger Crew Foreman was not notified by the department prior to the lift to verify tag, last required inspection, wire rope size, capacity, condition and assure cable integrity as required in the JTA, as this was a critical piece of equipment. It is believed one leg of the three leg 1/2 inch wire rope bridle was damaged prior to lifting, as it was not fully observable. Protective rubber hose casing used for protection partially covered wire rope slings. Any down time costs by Pit Ops are being accrued.       

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 ©Copyright 2012 Global Loss Control, Inc.

 

 

 

 

 

 

MAINTENANCE W O 

PRIORITY CLASSIFICATION

HAZARD (MAJOR)

Classification 1:

 A condition or practice likely to cause

permanent disability, loss of body part

or life, and/or extensive loss of physical

structure, process, critical equipment,

materials, environment, that may also

 cause consequence to the community.

 

HAZARD (SERIOUS)

Classification 2:

A condition or practice likely to cause serious

injury or illness, resulting in temporary disability,

property or process damage, and process

disruption affecting quality and/or environment within

a department or facility.

 

HAZARD (MINOR)

Classification 3: 

A condition or practice likely to cause minor,

non-disabling injury or illness, non-disruptive

property or process damage, minor product defects,

minor environmental impact.  

 

 



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