FORM E-PIR-1 Rev 08/04	EQUIPMENT/PRODUCT INFORMATION REPORTDEPARTMENT OF TRANSPORTATION EQUIPMENT UNIT
PIR NUMBER: DATE:
PLEASE SUBMIT 3 COPIES TO:							FROM:	TITLE:
FLEET SUPPORT MANAGER EQUIPMENT INVENTORY CONTROL UNIT DIVISION OF HIGHWAYS RALEIGH, NC 27606							CITY: DIVISION: DISTRICT:

EQUIP. NO. AND/OR D.O.T. PART NO.:		MAKE:			MODEL OR SERIES:		MILEAGE:	HOURS:
CLASS CODE:	YEAR MODEL:		SERIES NO. OR VIN NO.:
DATE EQUIPMENT OR ITEM RECEIVED NEW IN DIVISION:			REQUISITION NO.:		DATE OF DEFECT OR TROUBLE:	WAS EQUIPMENT OR PART RECEIVED FROM:
						DEPOT? CENTRAL INVENTORY? OR OTHER SOURCES?

ITEM REPORT COVERS: (IDENTIFY BY PART NUMBER AND NAME)

NATURE OF DEFECT OR TROUBLE:

DESCRIBE WORK NECESSARY TO CORRECT (INCLUDE VMRS CODE(S) ):

HAVE YOU REPORTED THIS CONDITION BEFORE? (IF YES, LIST PIR NUMBERS AND DATES):

HAS UNIT BEEN REPAIRED?       YES        NO          DATE REPAIRED:

PARTS FURNISHED BY: LABOR FURNISHED BY:

REMARKS:

SHOULD DOT BE REIMBURSED FOR:         PARTS    YES    NO                 LABOR    YES    NO

SIGNED: