Title Page

  • Tech Name

  • Tech Number

  • Van Number

  • Order Location

  • Ship Location

Tool Order

Tool Information

  • * Items submitted as lost or broken will be payroll deducted.

  • * Items submitted as not issued will require FSM or Fleet Manager approval.

  • * Items submitted as worn require the explanation below, a photo of worn item, and FSM approval.

Satellite Tools

  • Satellite - Part# & Item Description

  • Cause

  • Explanation for Worn

  • Add media

  • Do you require additional Tools?

  • Part# & Item Description

  • Cause

  • Explanation for Worn

  • Add media

  • Do you require additional Tools

  • Part# & Item Description

  • Cause

  • Explanation for Worn

  • Add media

  • Do you require additional Tools

  • Part# & Item Description

  • Cause

  • Explanation for Worn

  • Add media

  • Do you require additional Tools

  • Part# & Item Description

  • Cause

  • Explanation for Worn

  • Add media

Samsung Tool

  • Samsung Tool - Parts # & Description

  • Cause

  • Explanation for Worn

  • Add media

  • Do you require additional tools

  • Part# & Item Description

  • Cause

  • Explanation for Worn

  • Add media

  • Do you require additional tools

  • Part# & Item Description

  • Cause

  • Explanation for Worn

  • Add media

  • Do you require additional tools

  • Part# & Item Description

  • Cause

  • Explanation for Worn

  • Add media

  • Do you require additional tools

  • Part# & Item Description

  • Cause

  • Explanation for Worn

  • Add media

Sears Tool

  • Sears Tool- Parts# & Description

  • Cause

  • Explanation for Worn

  • Add media

  • Do you require additional tools

  • Parts # & Description

  • Cause

  • Explanation for Worn

  • Add media

  • Do you require additional tools?

  • Parts # & Description

  • Cause

  • Explanation for Worn

  • Add media

  • Do you require additional tools?

  • Parts # & Item Description

  • Cause

  • Explanation for Worn

  • Add media

  • Do you require additional tools?

  • Parts # & Item Description

  • Cause

  • Explanation for worn

  • Add media

  • Technician Acknowledgement: I attest that all the information is true and provided to the best of my ability.

  • Technician should STOP here on filling out this form and email to their supervisor for approval. Hit "Save" at the top of the screen. Open the document in "In Progress & Complete". Export as a PDF, Preview Report, upload and send by email to yourself & your supervisor.

Charges, Cost of Items, plus Tax

  • Total Cost of items being charged: Sub Total

  • Tax

  • Total to be Charged

  • *The item(s) that you are being charged for have been identified above, the total being listed above.

Authorization

  • Supervisor's Signature

  • If there is any charge that needs to be deducted from payroll, a technician's signature is required.

  • Technician's Signature: I hereby acknowledge and agree to the above amount to be deducted from my paycheck(s)

DRS Purchasing

  • Date:

  • Fax Date:

  • Defective Item Returned:

  • HD PO#:

  • DOW SO#:

  • The above items will be shipped with the exception of






The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.