Anonymous

Selfridges Works

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Use this Template

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Information

Store Name:
Conducted on

Ad-Hoc Works Sign Off

Installation Details

Store Name:
Activity Date:
Engineer Name:
Areas Worked In
Access Equipment Used
Any Fire Seals Broken/Breached
If any Fire Seals Broken/Breached, please provide photo.
Next shifts planned works
Security areas and supporting photographs
Add media

Engineers Comments

Engineer comments:
Any issues
Outstanding works

Supporting Photo's

Photos

Please provide supporting photo's for the work that you have carried out
Supporting Photo's

Customer Sign Off

Please note that this should be completed by the Duty Manager - the purpose of this form is to verify that the works performed by the engineer is as per the 'Purpose of the Visit'.
Time Onsite
Time Off site
Engineers Sign Off:
Customer Sign Off:

Anonymous

Selfridges Works

Use this Template

Print as PDF

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.