Completion report (additional copy)
• Safety inspection for machine type 3592
• General safety inspection
• Maintenance agreement qualication (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 DATE SERIAL NUMBER
SAFETY HAZARDS
LIST ALL SAFETY HAZARDS. IF NONE, SAY NONE.
1. ____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
5. ____________________________________________________________________
6. ____________________________________________________________________
7. ____________________________________________________________________
8. ____________________________________________________________________
9. ____________________________________________________________________
10. ____________________________________________________________________
Complete this report to nalize the safety inspection.
Safety and Inspection
165
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