Unsatisfactory equipment report




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AID5-236(7-64)

AGENCY FOR INTERNATIONAL DEVELOPMENT

DATE

UER



UNSATISFACTORY EQUIPMENT REPORT

REPORT

     


FAULT

     


INSTRUCTIONS - Prepare this report within five days after deficiency occurs, routing as indicated in "TO" box. Complete all boxes and describe completely the details of the deficiency and the action taken to date for correction. Prepare reports on deficiencies that have been satisfactorily corrected by manufacturer or his representative, especially when deficiency is a result of noncompliance with specification or other requirements. A recurrence of a deficiency, after repairs or replacement of parts have been effected, will be the subject of an additional report referencing the previous report.

TO:

Overseas Management Support Division

Agency for International Development

Washington, D.C. 20523



FROM:(Give complete address)

     


ACQUISITION DATA

PURCHASE ORDER NUMBER

     


FOB

 DESTINATION  ORIGIN



DATE IN SERVICE

     


DESCRIPTION OF DEFECTIVE EQUIPMENT

NAME OF EQUIPMENT

     


MODEL

     


TAG NUMBER

     


MANUFACTURER

     


MILES OR HOURS

     


NUMBER OF IDENTICAL

ITEMS ON HAND

     


DETAILS (GIVE APPARENT CAUSE, RECOMMENDATIONS AND ACTIONS TAKEN)

     



PREPARED BY (SIGNATURE AND TITLE)

CONTACT FOR INFORMATION

TELEPHONE

     

     

NUMBER

     


EXTENSION

     


AID5-236(7-64)


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