About this Form
Form number: 345-23A
Audience: School Staff
Last revised: November 2004
INSTRUCTIONS: This form is to be completed by the elementary physical education teacher. Place an (X) in the space to indicate what items were inspected and the repairs needed. If there are additional items and/or repairs not contained on this form, place in the columns or rows designated OTHER and identify the equipment and type of repair that is necessary. Prepare a work order for items needing repair and forward the work order to the area maintenance supervisor.
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