Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Date received
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City and Number
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Customer name
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ESI Order number
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Claim type
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Installation Date (MM,DD,YYYY) REQUIRED
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Damage claims must include photo of damage. Include photo of labels for incorrect items. Note: Also attach photos and send by email to dmahen@championfactorydirect.com
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List items here. Quantity, Item Number, Description
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Your Signature
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Root Cause Analysis
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Corrective Countermeasure
