Title Page
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Prepared by
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Conducted on
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Location
Starting information
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Store Name
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Urgency for the Request
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Other please advise
Request Details
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Category
- Lighting
- HVAC
- Electrical
- Plumbing
- Glazing
- Flooring & Walls
- Ceiling
- Doors
- Other - Please state below
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Location of Issue
- Sales floor (public area)
- Entrance
- External to store
- Office area
- Stockroom
- Staff area
- Toilets
- Staircase
- Other location - please state below
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Other location
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Details of Issue
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Picture of Issue
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Has this issue occurred before?
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Is it a H&S Issue?
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Is it preventing trading within the store?
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Site contact/s
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Any other information
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Please sign