Title Page

  • Site Conducted:

  • Conducted On:

  • Prepared By:

  • Location:

Store Info

  • Store Name

  • Store Number

  • Work Permit Completed ATL (General)

  • Electrical Permit Completed By Electrician (Electrical)

  • Person Signing On Permits

On Site Personnel Info

  • Total number of engineers:

  • Photo’s of ALL engineers CSCS cards:

  • Photos of ALL engineers appropriate certificates (according to the store being worked on):

  • Photo of site board on display:

  • Photo of Site register with names:

  • Photo of signed RAMS:

Install

  • Store handed back fit to trade?

  • Please explain:

  • Job completed as per SOW?

  • Please explain:

  • Have we used old floor trunking & tri lights?

  • Please explain:

  • Have new skirts been fitted to SSC?

  • Please explain:

  • Have front doors been removed off old SSC for recycling?

  • Please explain:

  • Have all SSC been bolted down?

  • Please explain:

  • Have XR7 heads been removed from old SSC, boxed up & returned to Holford?

  • Please explain:

  • If SSC being removed have 7879 scales have these been removed, boxed up and returned to Holford?

  • Please explain:

  • Have end of trip barcode stickers been applied by NCR engineer?

  • Please explain:

  • Have scanner holders been transferred from old to new basket shelves?

  • Please explain:

  • Has card only/card & cash signage been transferred from old SSC to new SSC or left with store?

  • Any of site issues?

  • Please explain:

  • Site lead / Engineers comments:

  • Photo’s Of installation:

Evidence

  • Photo of site before works begun:

  • Photo of filled holes in floor:

  • If patched, photos of wall skirts:

  • Completion of work photos:

Sign Off Permits

  • Electrical permit signed off:

  • ATL general permit signed off:

  • Person who signed off permits:

Engineers Sign Off

  • NCR lead engineer sign:

  • Electrician companies name:

  • Electrician lead engineer sign:

  • ATL lead engineer:

  • Main contractor sign:

Job Sign Off To Be Signed By Store

  • Job title:

  • Sign:

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