Title Page

Form Details:

  • Assigned:

  • Updated:

  • Form Reference:

Claim Information:

  • CET Reference:

  • Insured Name:

  • Client:

  • Date Of Complaint:

  • Repair Team:

  • Repair Leader:

  • Date Of Visit:

  • Time:

  • Present During Visit:

  • Address:
  • Contact Tel No:

  • Description of Complaint / Concern:

Repair Team Comments:

  • Add media

Repair Leaders Findings:

  • Add media

Resolution:

  • Resolution Date Agreed?

  • Resolution Date:

  • All Parties Aware of the Dates?

  • Concerns / Complaints Justified:

  • Is Compensation Due?

  • If Yes, Who are we receiving monies from?

Additional Information:

Signatures:

  • CET Representative:

  • Insured / Representative:

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.