ROBUS Failure Report form 066

• Prepared by

• Conducted on

  Date

• Form 066 Office Use only QC22-

Wholesaler Information

• Wholesaler Name

• Original Invoice/ Purchase order number

• Product Code

• Date of purchase

  Date

• Product Description

• Has the Wholesaler raised an RFC for these goods?

  Yes

  No

Contractor Information

• Company Name or Customer Name

• Contact Phone Number

• Installation Address
  Address

• Installation Date

  Date

• Fault Detection Date

  Date

• Batch Number

• Number of units installed

• Number of units Faulty

• Premises desciption

  Commercial

  Domestic

Installation Information

• Fault Description

• Has the light been installed

  Yes

  No

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

  Media

• Product install location

  Select Bathroom Kitchen Bedroom Lounge Outside Other

  • Bathroom
  • Kitchen
  • Bedroom
  • Lounge
  • Outside
  • Other

• Please Specify

• Take picture of the issue with the light fitting

  Media

• Daily Operation Hours

• Lighting control system description

  Select Light switch Dimmer Sensor Remote Control WIFI Controller/ App control DALI Other

  • Light switch
  • Dimmer
  • Sensor
  • Remote Control
  • WIFI Controller/ App control
  • DALI
  • Other

• Please specify

• Ambient Temperature

Suggested Solution

• Yes

  No

  N/A

• Proposed solution

  Replace fittings

  Other

• Summery

• Units Required to be returned to Robus Technical

  Yes

  No

• Quote Required

  Yes

  No

  N/A

• Quote Number

When Complete Email to Robus Technical

• Yes

  No

  N/A