# Maintenance incident report

Prepared by Reliabotix — https://reliabotix.com/guides/maintenance-incident-report
Blank template, published September 13, 2026. Copy and adapt for internal use.
Use approved site procedures for work and acceptance. This is a record template, not an equipment procedure.

## 1. Identity and reported symptom
- Incident reference:
- Asset / line / site:
- Record owner:
- Event window and time zone:
- Reported symptom:
- Reported by / observed by:
- Observation method (direct physical observation, reported signal, operator account):
- Operating context / known configuration revision:
- Confirmed downtime interval, or unknown:

## 2. Evidence register
Keep original sources intact. Add rows as needed.

| Evidence ID | Original source and retrievable reference | Event time and time zone | Receipt time if supplied | Evidence kind | Signal / value / units or observation | Quality and documented mapping | Limitations |
|---|---|---|---|---|---|---|---|
| E001 | | | | | | | |

- Clock alignment and known uncertainty:
- Missing intervals / missing sources:
- Repeated samples and duplicate-import handling:

## 3. Sequence and interpretation
- Supported observation(s) with evidence IDs:
- Hypothesis 1:
  - Supporting evidence:
  - Conflicting evidence:
  - Missing evidence / alternative explanations:
- Next evidence needed:
- Applicable approved manual / procedure / revision:

## 4. Cause and corrective work
- Cause status: UNCONFIRMED / CONFIRMED
- Confirmed cause, if established:
- Supporting evidence IDs:
- Qualified reviewer and review date:
- Proposed action (not yet performed):
- Action actually performed, by whom and when:
- Approved procedure / work authorization reference:

## 5. Verification and restoration
- Restoration status: UNKNOWN / NOT RESTORED / RESTORED
- Applicable approved acceptance procedure and revision:
- Verification results and supporting records:
- Reviewer / responsible person / review time:
- Remaining limitations or recurrence risk to review:

## 6. Handoff and reuse
- Next task:
- Owner / due date:
- Outcome / evidence reference:
- Unresolved questions:
- Knowledge status: CANDIDATE / REVIEWED FOR REUSE
- Conditions and limits for reusing this incident:
- Review and correction history:

Use “unknown,” “not supplied,” or “not applicable with reason” rather than leaving an ambiguous blank. A generated suggestion is not confirmation of a cause or a successful repair.