Customer Information

  • Enter Customer of Asset:

  • Customer Contact info: (Contact Name and Contact Phone#)

  • Asset Details
  • Enter Asset Location Name:

  • Enter Model Name:

  • Enter Manufacturer:

  • Enter Serial#

  • Is Cycle Counter Value available?

Service Required

  • Type of Service is being Requested:

  • Brief description of Service Request:

  • Reported Fault:

  • System State Prior to Service

  • Comments:

  • Prior to start of ANY Service is there any Visual Damages to AVB? Make a note and take Picture(s)!

  • Travel Time to Site

  • Travel Time Return

  • Comments / General Notes:

  • LABOR
  • SERVICE TECH NAME

  • Time In

  • Time Out

  • PARTS (TAKE PICTURES OF ALL DAMAGE PARTS THAT ARE BEING REPLACED)
  • Where there any parts used?

  • Enter Part Number:

  • Enter Manufacture:

  • Enter Serial number if available

  • EQUIPMENT RENTAL
  • WAS THERE ANY EQUIPMENT RENTAL REQUIRED/USED?

  • Rental Equipment Description:

  • SERVICES / REPAIRS
  • DESCRIBE ALL SERVICES / REPAIRS THAT WERE PERFORMED

  • Technician Service/Comments/Recommendations

  • Pictures of Work Performed

  • Was Service Complete

  • Items/Work to be Completed

  • Schedule Return Date

  • Total Travel Time

CUSTOMER SERVICE ACCEPTANCE

  • END-USER/CUSTOMER SIGNATURE

  • NASATKA REP SIGNATURE

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. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.