• Site number:

  • Store name:

  • Conducted on

Store Information

Store Information

  • Store Number:

  • Store Name:

  • Engineer:

  • Activity Date:

Issue Log

Issues Log

  • Have any issues been discovered?

  • Provide details of issue

  • Please provide photo of issue

  • Was the issue resolved?

  • Photos of resolved issue

Outstanding Issue Log (Provide details of each outstanding issue below)

  • Were there any issues you were unable to resolve?

  • Outstanding Issue
  • Details

Customer Sign Off

Engineer Sign Off

  • Completion date

  • Time onsite

  • Time off site

  • Engineer sign off

Customer Sign Off

  • Site left clean and tidy?

  • Customer comments

  • Customer sign off

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.