If 'Other' Please Give Description
Description of Defect
Works Carried Out
Return Visit Required?
If "YES" please state details of time & materials required
Contra Charge Applicable?
If "YES" state name of guilty party if known
Total Time (Hours and Minutes) to complete works including travel
BY SIGNING THIS FORM YOU ARE CONFIRMING THE WORK HAS BEEN COMPLETED AND YOU ARE SATISFIED WITH THE REPAIR OR THE TEMPORARY RESOLUTION UNTIL THE REPAIR CAN BE COMPLETED.