Generic Field Service Report Template

• Field Service #

• Equipment Owner

• Address
  Address

• Contact #

• Conducted on

  Date

• Prepared by

Field Service Report

• Work to be performed

  Repair

  Maintenance

  Installation

  Other

• Please specify work to be performed

• Description of work

• Take a photo of the problems identified

  Media

• Actions performed

• Have you completed work?

  No

  Yes

Follow Up Action Items

• Click + to add Action items

Room/Area/Zone

• Description of issue and open item

• Recommended action

• Target date

  Date

Defective / Damaged Device Summary Report

• Click + to add devices replaced

Device

• Qty

• Part #/Date code

• Covered under warranty?

  No

  Yes

• Description of Symptom/Failure/Cause

• Click + to add devices needs to be ordered

Device

• Qty

• Part #/Date code

• Covered under warranty?

  No

  Yes

• Description of Symptom/Failure/Cause

Completion

• I confirm that the performed work, issues encountered, corrective actions, and follow up action items as stated in this report are accurate.
  
  If the required work is completed and that all issues were resolved; I confirm that system functionality, and any applicable system integration meets the design specifications.
  
  If follow up action items are required; I confirm that I will perform all of the necessary steps to complete all of the follow-up action items that are of my responsibility as stated in this report.

• Technician/Service Practicioner Full Name and Signature

  Sign

• End User / Owner Name and Signature

  Sign

• Field Service Engineer Name and Signature

  Sign