Information
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Store Number:
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Store Name:
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Conducted on
Ad-Hoc Works Sign Off
Installation Details
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Store Number:
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Store Name:
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Activity Date:
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Engineer Name:
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Have RAMs been read and signed?
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If 'No' provide details
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Purpose of Visit
(Please enter details of fault below) -
Fault 1
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Fault 2
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Fault 3
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Fault 4
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Fault 5
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Has fault 1 been repaired successfully? Please provide details on what was done to fix.
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If 'No' provide details
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If 'yes' provide details on what was done in order to fix
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Please insert photo of test result for Fault 1
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Has Fault 2 been repaired successfully?
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If 'No' provide details
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If 'yes' provide details on what was done in order to fix
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Please insert photo of test result for Fault 2
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Has fault 3 been repaired successfully?
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If 'No' provide details
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If 'yes' provide details on what was done in order to fix
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Please insert photo of test result for Fault 3
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Has fault 4 been repaired successfully?
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If 'No' provide details
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If 'yes' provide details on what was done in order to fix
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Please insert photo of test result for Fault 4
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Has fault 5 been repaired successfully?
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If 'No' provide details
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If 'yes' provide details on what was done in order to fix
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Please insert photo of test result for Fault 5
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If any faults require a revisit, or re-cabling, please provide details of what is required? i.e what lifter is required? What is the length of the cable? does this need to be OOH?
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Engineer comments:
Supporting Photo's
Photos
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Please provide supporting photo's for the work that you have carried out
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Supporting Photo's
Customer Sign Off
Customer Sign Off
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Please note that this should be completed by the Duty/Delivery Manager - the purpose of this form is to verify that the works performed by the engineer is as per the 'Purpose of the Visit'.
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Time Onsite
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Time Off site
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Engineers Sign Off:
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Customer Sign Off:
