Title Page

  • Prepared by

  • Conducted on

  • Form 066 Office Use only QC22-

Wholesaler Information

  • Wholesaler Name

  • Original Invoice/ Purchase order number

  • Product Code

  • Date of purchase

  • Product Description

  • Has the Wholesaler raised an RFC for these goods?

Contractor Information

  • Company Name or Customer Name

  • Contact Phone Number

  • Installation Address
  • Installation Date

  • Fault Detection Date

  • Batch Number

  • Number of units installed

  • Number of units Faulty

  • Premises desciption

Installation Information

  • Fault Description

  • Has the light been installed

  • Take picture of the light in it's installed location

  • Product install location

  • Please Specify

  • Take picture of the issue with the light fitting

  • Daily Operation Hours

  • Lighting control system description

  • Please specify

  • Ambient Temperature

Suggested Solution

  • Proposed solution

  • Summery

  • Units Required to be returned to Robus Technical

  • Quote Required

  • Quote Number

When Complete Email to Robus Technical

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