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• Site Name:

• ISG Call Ref. Number:

• Customer Ref. Number:

• Room Number/Location:

• Engineer:

• Conducted on

  Date

• Brief description of fault:

• Action taken:

• Materials used:

• Is fault resolved ?

  Yes

  No

• If No then please provide further details:

• Picture of test results:

  Media

Signed off by :

• Accommodation team:

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• Or resident:

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