Sky uk Engineer Companion VR 01/09/17

Engineer Companion

• Engineer details (**payroll number must be included**)

• Conducted on

  Date

• Prepared by

• Choose Document

  Select Proof of understanding Generic risk assessment Escalation form Tool box Talks Order Safety Equipment Nonstandard Visit Escalated Q Visit New start Check list Parking Fine Form Bskyb Sky Revisit Feedback SAT Risk Assessment and Method Statement (RAMS) FORM Sky Vehicle Appraisal Form

  • Proof of understanding
  • Generic risk assessment
  • Escalation form
  • Tool box Talks
  • Order Safety Equipment
  • Nonstandard Visit
  • Escalated Q Visit
  • New start Check list
  • Parking Fine Form Bskyb
  • Sky Revisit Feedback
  • SAT Risk Assessment and Method Statement (RAMS) FORM
  • Sky Vehicle Appraisal Form

Escalation Form

• Job Numbe

• Post Code

• Point of Escalation

• Equipment Used

  Select 20mm eye bolt Seat belt 5m rope with knot Crawl boards Slings Chimney strop Cowstail Rope grab Harness Ladder spike/leg Gravel bag 1m ratchet strap (between microlite and access ladder)

  • 20mm eye bolt
  • Seat belt
  • 5m rope with knot
  • Crawl boards
  • Slings
  • Chimney strop
  • Cowstail
  • Rope grab
  • Harness
  • Ladder spike/leg
  • Gravel bag
  • 1m ratchet strap (between microlite and access ladder)

• Comments (Detail any unseen equipment)

• Photo of Set Up

  Media

• I have escalated this visit and after discussing options with the TM i am happy to proceed with this visit using this safe system of work

  Sign

Proof of Understanding

• Choose Document

  Select Escalation Manual Hazard Awareness manual Generic risk assessments Safety Manual Combi ladder manual Lone working policy First aid policy Absence policy Fleet policy Drugs and alcohol policy PPE Manual Statement of arrangements Cladded building brief Safe ladder access on public highways Summer manual Winter Manual Manual handling Brief Critical Hit Brief DAMAGE Awareness Documents

  • Escalation Manual
  • Hazard Awareness manual
  • Generic risk assessments
  • Safety Manual
  • Combi ladder manual
  • Lone working policy
  • First aid policy
  • Absence policy
  • Fleet policy
  • Drugs and alcohol policy
  • PPE Manual
  • Statement of arrangements
  • Cladded building brief
  • Safe ladder access on public highways
  • Summer manual
  • Winter Manual
  • Manual handling Brief
  • Critical Hit Brief
  • DAMAGE Awareness Documents

• • Escalation process
  • Pitched roof work
  • Dormer roof work
  • Flat roof work
  • Safe access through windows
  • Accessing skylights and roof hatches in tenement properties
  • Use of existing dish bracketry to secure ladders
  • Using anchors positioned at the base of a wall or ground level
  • Access to scaffolding at residential premises
  

• • Identifying fragile roof surfaces
  • Asbestos
  • Working around dogs
  • Hazard awareness
  • Health and safety: Awareness and principles
  • Hazardous substances
  • Internal RA & hazard awareness brief
  
  
  

• animal faeces . working in sunshine
  

• • Bosch GMS-120 detector Equipment
  • PPE Brief
  • PPE policy

• Have you read and fully understood all the above named document and do you understand your responsibilities

  Yes

  No

• Please inform your line manager of your further support/training requirements in understanding the above named document

• Signature

  Sign

• Signature

  Sign

Hazard Awareness

• Choice Document

  Select Manual Handling Risk Assessment PPE Surfaces Risk Assessment Aggressive People Risk Assessment Driving Risk Assessment Climbing Apparatus Risk Assessment Working at Height Risk Assessment Inclement-adverse weather RA Lone Working Zoonose Risk Assessment

  • Manual Handling Risk Assessment
  • PPE
  • Surfaces Risk Assessment
  • Aggressive People Risk Assessment
  • Driving Risk Assessment
  • Climbing Apparatus Risk Assessment
  • Working at Height Risk Assessment
  • Inclement-adverse weather RA
  • Lone Working
  • Zoonose Risk Assessment

• I have read all the generic risk assessments listed above and fully understand them and all the relevant control measures.<br>

  Yes

  No

• Please inform your line manager of your further support/training requirements in understanding these risk assessments

• Signature

  Sign

• I have read the generic risk assessments listed above and fully understand them and all the relevant control measures.

  Sign

Tool Box Talks

Order Safety Equipment

• What item have you replaced?

• Media

• Serial Number

• What Date did you receive this item?

  Date

• What Date of manufacture is on the item?

  Date

• Please forward this form to your Line Manager so that an inspection can be arranged.

• Sign

  Sign

Escalated Q Visit

• 

• Job Number

• Reason for escalation

  Hardwire

  Other

• Please give full details for this escalation and and the possible solutions!

• Why does it need hard wiring....IE...Oast house, distance too far etc

• What is the Approximate Age of the house?

• Does the property have a Basement?

  Yes

  No

• Pictures of the property

  Media

• What are the location of the STB,s?

• What measures have you taken to use it wirelessley....IE booster placement

• Add Media to Support

  Media

• How many Items need hard wiring?

• Add Media to Support

  Media

• What route has been discussed with the customer?

• Please give a diagram

  Drawing

• Who Provides the customers Broadband?

  Select SKY BT Virgin Plus Net EE O2 Talk Talk Vodafone SSE Direct Save Other

  • SKY
  • BT
  • Virgin
  • Plus Net
  • EE
  • O2
  • Talk Talk
  • Vodafone
  • SSE
  • Direct Save
  • Other

• What type of BT router has the customer got?

• Please provide details of the broadband supplier.

• Add Media to Support

  Media

• Please provide picture of current metrics

  Media

• Pictures of layout of equiptment... IE in a cabinet, etc

  Media

• Have you used I Know 2?

  Yes

  No

• Please give reason for not using I Know 2

• TM contacted Prior to escalation?

  Yes

  No

• Please give reason for not contacting your TM?

• What was discussed with your TM?

• Has the customer been made aware of the potential wait for this escalation to be resolved!<br>

  Yes

  No

• Engineer

  Sign

Nonstandard Visit

• Job Number

• Date and Time of Visit

  Date

• Reason

• Add media to support

  Media

Disclaimer

• “I confirm that I am satisfied that the Sky Engineer has left my property safe and clean and that the installation has been performed to my satisfaction and I am happy with the results.”

• Customers Signature

  Sign

• Engineers Signature

  Sign

Health and Safety Equipment

• Please select all Health and Safety items the engineer has on the vehicle

  Select Microlite Ladder Attachment (UOM 1) Cones Standard 21 Inch (UOM 1) Drill Harness Kneepads External 6m Chimney Strop Standard Karabiner Gravel Bag 30cm Endless sling for seatbelt (RSL) Sling 150 cm (qty 1) Seat Belt (Retractable Safety Line) 9m Ratchet Strap Kit 15mm x 11mmKernmantleRope(UOM = 1) 10m x 11m Kernmantle Rope (UOM = 1) 5m x 11mm Kernmantle Rope (UOM = 1) 1.5m Para Cord Para Cord Karabiner Y Hang Sling 4m Ratchet Strap 1.2M Endless Soft Sling DTH Harness Rope Grab (UOM 1) Cows Tail Re usable eyebolt anchor (UOM 1 = 1) 1m Ratchet strap 2 Mtr Ratchet Strap (UOM 1) Pipe Cutter UOM = 1 Silicon Cutter UOM = 1 Hazard Analysis Form (DTH & DAT) Skylite Crawl board (UOM = 1 Pair) Lashing Kit gloves Scanner Bosch GMS120 Ladder Spike 10mm x 75mm Screw Eye Bolt ( UOM1=1) Cable Rod Kit (Standard Issue) UOM = 1 K Ladder Mate (UOM 1) Draper working light Snow Gripper Size 11+ boot Snow Gripper Size 5-10 boot Snow Gripper Size 4 boot

  • Microlite Ladder Attachment (UOM 1)
  • Cones Standard 21 Inch (UOM 1)
  • Drill Harness
  • Kneepads External
  • 6m Chimney Strop
  • Standard Karabiner
  • Gravel Bag
  • 30cm Endless sling for seatbelt (RSL)
  • Sling 150 cm (qty 1)
  • Seat Belt (Retractable Safety Line)
  • 9m Ratchet Strap Kit
  • 15mm x 11mmKernmantleRope(UOM = 1)
  • 10m x 11m Kernmantle Rope (UOM = 1)
  • 5m x 11mm Kernmantle Rope (UOM = 1)
  • 1.5m Para Cord
  • Para Cord Karabiner
  • Y Hang Sling
  • 4m Ratchet Strap
  • 1.2M Endless Soft Sling
  • DTH Harness
  • Rope Grab (UOM 1)
  • Cows Tail
  • Re usable eyebolt anchor (UOM 1 = 1)
  • 1m Ratchet strap
  • 2 Mtr Ratchet Strap (UOM 1)
  • Pipe Cutter UOM = 1
  • Silicon Cutter UOM = 1
  • Hazard Analysis Form (DTH & DAT)
  • Skylite Crawl board (UOM = 1 Pair)
  • Lashing Kit gloves
  • Scanner Bosch GMS120
  • Ladder Spike
  • 10mm x 75mm Screw Eye Bolt ( UOM1=1)
  • Cable Rod Kit (Standard Issue) UOM = 1 K
  • Ladder Mate (UOM 1)
  • Draper working light
  • Snow Gripper Size 11+ boot
  • Snow Gripper Size 5-10 boot
  • Snow Gripper Size 4 boot

• How many cones are on the vehicle (Min 2)

• How many karabiner's are on the vehicle (Min 7)

• How many para cord karabiner's are on the vehicle (Min 2)

• How many Y hang sling's are on the vehicle (Min 2)

• How many soft slings are on the vehicle (Min 2)

• How many Re usable eyebolt's are on the vehicle (Min 2)

• How many 10mm eye bolts are on the vehicle (Min 2)

BRACKETS/MOUNTS

• Please select all Brackets/Mounts on the engineers has on the vehicle

  Select 1.25 Inch Patio Mount (Small)(UOM 1) New 1.4m S-Pole 1m S-Pole Single Lashing Kit including brackets ( Triax MK4 Exhaust Clamp (UOM =1 bag of 1

  • 1.25 Inch Patio Mount (Small)(UOM 1)
  • New 1.4m S-Pole
  • 1m S-Pole
  • Single Lashing Kit including brackets (
  • Triax MK4 Exhaust Clamp (UOM =1 bag of 1

CONSUMABLES

• Please select all Consumables the engineer has on the vehicle

  Select *Twin core clip ( Black )(1 pack of 1000 *Twin core clip ( White )(1 pack of 1000 *7mm White Clip(Bag of 1000) *4.5mm White Clip (Box 1000)UOM *4.5mm Black Clip (Box 1000)UOM *Cable Entry Cover (White)(1 bag of 50) *Cable Entry Cover (Black)(1 bag of 50) *7mm Black Clips(1 Box of 1000) Arco Branded Antiseptic Wipes (Tub of 20) 5mm x 50mm S4 W/L SDS Drill Bit (UOM 1 = Multimeter (DT-9201A) (UOM 1) Sealant Clear (UOM = 1 box of 6) 14mm R Staples (Box 1000)UOM *White Insert Plug(1 bag of 100) *Black PVC Tape (UOM = 1 roll) 160mmx4.8mm Cable Tie black short (1bag) 160mm x 4.8mm Cable Tie natural short *7mm White Bushing (1 Bag of 100) M8 x 60 Coach Screws (1 box of 100) *Sky + Grommet (UOM 1 pack of 100) ADSL Filter Padlock (Class 6)(UOM 1) Disposable Gloves ( box of 100) *Disposable overshoes(1 pack of 100) Unigrip Adhesive (UOM = 1 Tube) Plasters (pack of 20) First aid kits (UOM 1) *Black insert plug ( Box of 100 ) *10mm Nylon Plug (1 Bag of 500) Compression F-Fit Connector Sky+ (1 =50) Compression F-Fit Connector 1 = bag 50 SDS Drill Bit 10mm x 160mm SDS Drill Bit 6mm x 450mm SDS Drill Bit 10mm x 460mm Drill Bit 16x460mm (UOM 1 = 1) 20/200 drill bit (UOM 1) 10mm x 1m Drill Bit (UOM 1)

  • *Twin core clip ( Black )(1 pack of 1000
  • *Twin core clip ( White )(1 pack of 1000
  • *7mm White Clip(Bag of 1000)
  • *4.5mm White Clip (Box 1000)UOM
  • *4.5mm Black Clip (Box 1000)UOM
  • *Cable Entry Cover (White)(1 bag of 50)
  • *Cable Entry Cover (Black)(1 bag of 50)
  • *7mm Black Clips(1 Box of 1000)
  • Arco Branded Antiseptic Wipes (Tub of 20)
  • 5mm x 50mm S4 W/L SDS Drill Bit (UOM 1 =
  • Multimeter (DT-9201A) (UOM 1)
  • Sealant Clear (UOM = 1 box of 6)
  • 14mm R Staples (Box 1000)UOM
  • *White Insert Plug(1 bag of 100)
  • *Black PVC Tape (UOM = 1 roll)
  • 160mmx4.8mm Cable Tie black short (1bag)
  • 160mm x 4.8mm Cable Tie natural short
  • *7mm White Bushing (1 Bag of 100)
  • M8 x 60 Coach Screws (1 box of 100)
  • *Sky + Grommet (UOM 1 pack of 100)
  • ADSL Filter
  • Padlock (Class 6)(UOM 1)
  • Disposable Gloves ( box of 100)
  • *Disposable overshoes(1 pack of 100)
  • Unigrip Adhesive (UOM = 1 Tube)
  • Plasters (pack of 20)
  • First aid kits (UOM 1)
  • *Black insert plug ( Box of 100 )
  • *10mm Nylon Plug (1 Bag of 500)
  • Compression F-Fit Connector Sky+ (1 =50)
  • Compression F-Fit Connector 1 = bag 50
  • SDS Drill Bit 10mm x 160mm
  • SDS Drill Bit 6mm x 450mm
  • SDS Drill Bit 10mm x 460mm
  • Drill Bit 16x460mm (UOM 1 = 1)
  • 20/200 drill bit (UOM 1)
  • 10mm x 1m Drill Bit (UOM 1)

CABLES/LEADS

• Please select all Cables/Leads the engineer has on the vehicle

  Select CT63 Dual Cable (Black) - 250m CT63 Dual Cable (White) - 250m CT100 Black 250M(1 reel of 250m) CT100 White 250M(1 reel of 250M) *Digi Pace Scart Lead(1 bag of 5)(UOM 1) Power Lead (1 Bag of 5)

  • CT63 Dual Cable (Black) - 250m
  • CT63 Dual Cable (White) - 250m
  • CT100 Black 250M(1 reel of 250m)
  • CT100 White 250M(1 reel of 250M)
  • *Digi Pace Scart Lead(1 bag of 5)(UOM 1)
  • Power Lead (1 Bag of 5)

TOOLS

• Please select all Tools the engineer has on the vehicle

  Select Cable Reel Stand (UOM 1) Draper 870PZB Expert Screwdriver (UOM 1 DraperH/D Diag Sidecutter (UOM 1 =1) Dustpan & Brush Set (1 Set) 15mm OE Spanner (UOM 1) Safety Cut Out Switches (UOM 1) Nightsearcher - HP910X LED Head Torch Tool Organiser (UOM 1) Rapid 36 Staple Gun (UOM 1) Tape Measure (3 Metre) 10mm Ratchet Spanner UOM 1 = 1 Telephone Test Engineer(UOM 1) Lashing Kit wire cutter Amtec Leather Tool Belt (UOM = 1) Sealant Gun Hammer Claw (UOM 1) Pliers Combination ( Heavy ) (UOM 1) Wrench 13x14mm Rachet Ring (UOM 1) Nut Spinner (UOM 1) Tool Bag (UOM 1) Drill(New)(UOM= 1 drill) Compression Fit F-Connector Tightener Cable Stripping Tool (UOM=1) 13mm 6 point Ratchet wrench Compression Tool (Plastic) (UOM=1)

  • Cable Reel Stand (UOM 1)
  • Draper 870PZB Expert Screwdriver (UOM 1
  • DraperH/D Diag Sidecutter (UOM 1 =1)
  • Dustpan & Brush Set (1 Set)
  • 15mm OE Spanner (UOM 1)
  • Safety Cut Out Switches (UOM 1)
  • Nightsearcher - HP910X LED Head Torch
  • Tool Organiser (UOM 1)
  • Rapid 36 Staple Gun (UOM 1)
  • Tape Measure (3 Metre)
  • 10mm Ratchet Spanner UOM 1 = 1
  • Telephone Test Engineer(UOM 1)
  • Lashing Kit wire cutter
  • Amtec Leather Tool Belt (UOM = 1)
  • Sealant Gun
  • Hammer Claw (UOM 1)
  • Pliers Combination ( Heavy ) (UOM 1)
  • Wrench 13x14mm Rachet Ring (UOM 1)
  • Nut Spinner (UOM 1)
  • Tool Bag (UOM 1)
  • Drill(New)(UOM= 1 drill)
  • Compression Fit F-Connector Tightener
  • Cable Stripping Tool (UOM=1)
  • 13mm 6 point Ratchet wrench
  • Compression Tool (Plastic) (UOM=1)

DISH/LNB

• Please select all Dish's/LNB's the engineer has on the Vehicle

  Select Generic - MK4 Quad LNB Generic Mk 4 Octo LNB Generic MK4 Zone 1 Dish Generic Wide Band LNB Generic Hybrid LNB

  • Generic - MK4 Quad LNB
  • Generic Mk 4 Octo LNB
  • Generic MK4 Zone 1 Dish
  • Generic Wide Band LNB
  • Generic Hybrid LNB

• How many MK4 Quad LNB's are on the vehicle (Min 10)

• How many MK4 Octo LNB's are on the vehicle (Min 2)

• How many MK4 Zone 1 Dish's are on the vehicle (Min 10)

• How many Wide Band LNB's are on the vehicle (Min 10)

• How many Hybrid LNB's are on the vehicle (Min 2)

STATIONARY

• Please select all Stationary the engineer has on the vehicle

  Select Install form (UOM 1) Stock Manifest Book (1 pad) Outcards V2 (UOM = 1 pad) Paper Risk Assessment Paper Job Sheets Bump Cards

  • Install form (UOM 1)
  • Stock Manifest Book (1 pad)
  • Outcards V2 (UOM = 1 pad)
  • Paper Risk Assessment
  • Paper Job Sheets
  • Bump Cards

• TM

  Sign

• Engineer

  Sign

PARKING FINE FORM BSKYB

• National parking Utl fleet

• Fine reference number

• Team Code

• Engineer Name

• Manager Name

• Engineer Number

• Van Registration

• Local Authority

• Cost

• Date fine occurred

  Date

• Job Number

• Road Name

• Authorised to pay

  Yes

  No

• Authorised to recharge engineer

  No

  Yes

• Reason for not recharging engineer

• Photo of notification of parking issue before receiving fine

  Media

• Photo of fine, vehicle parked and signage displaying terms

  Media

• Team Manager submitting form

• Date submitted and emailed to UTL utl.bskyb.fleet@unipart.com

  Date

SKY REVISIT FEEDBACK

• Please fill out on every 30/90 day revisit
  

• Each section of this form must be completed

• job Number

• Previous engineer

• Job type

  SKY Q

  SKY CLASSIC

• Revisit on

  INSTALL

  SERVICE

• Date of original job

  Date

• What is the issue with job

  Select No sat signal Connectivity issues Broadband related OSM fault Picture fault UHD fault Other

  • No sat signal
  • Connectivity issues
  • Broadband related
  • OSM fault
  • Picture fault
  • UHD fault
  • Other

• Explain in brief the issue with system

• Screen shots of equipment locations (Sky Q only)

  Media

• Was the HDMI cable changed?

  Yes

  No

• Is there a reason the HDMI has no been changed?

• Was the POWER cable changed?

  Yes

  No

• Is there a reason the Power Lead has no been changed?

• Was the F CONNECTORS changed?

  Yes

  No

• Screen shots of mesh from chrome before and after (Sky Q only)

  Media

• Any additional photos to be added to help understand revisit

  Media

• Resolution of the fix to the system

• Feedback to original engineer

• Engineer Sign

  Sign

SAT Risk Assessment and Method Statement (RAMS) FORM

• This form assumes that the job cannot be completed by a DTH or DAT engineer. A form must be completed for each SAT job before it is undertaken. SAT jobs require two trained and qualified SAT Engineers on site at all times otherwise they must must be postponed. Modern Apprentices may not take part in SAT Work.

• Job Number

• Climbing Engineer

• Safety Engineer

• Job Type

• Date

  Date

• 1. Is the job a true SAT job?

  Yes

  No

• If it is not SAT, it is...

  DTH

  DAT

  Impossible to Complete

• If the job is DTH or DAT or Impossible, State the reason why here

The following information constitutes an on-site assessment for the job. A Method Statement is also required

• 2. Access to height will be by:

  Ladder

  Via a Dormer

  Via a Velux window or Rooflight

  Other means - Please give details below

• If Other Specify minimum control measures required.

• If Additions to or Variations from standard control measures - please specify clearly here.

• 3. Type of ladder to be used: (if applicable)

• Combi Ladder Standard Control Measure Requirements (as per Ladder Hierarchy) PPE, Other equipment and Fall Arrest as necessary, Eyebolt at all times

• 8-rung Ladder Standard Control Measure Requirements (as per Ladder Hierarchy) PPE Microlite + Eyebolt necessary to ensure security.

• Single Section Ladder Standard Control Measure Requirements (as per Ladder Hierarchy) PPE, Microlite, LadderMate, Full Fall Arrest + EyeBolt

• Double Section Ladder Standard Control Measure Requirements (as per Ladder Hierarchy) PPE, Microlite, LadderMate, Full Fall Arrest + EyeBolt

• Triple Section Ladder Standard Control Measure Requirements (as per Ladder Hierarchy) PPE, Microlite, LadderMate, Full Fall Arrest + EyeBolt

• DAT Roof Ladder Standard Control Measure Requirements (as per Ladder Hierarchy) PPE, 2 x Microlite, 2 x LadderMate, 3 x Full Fall Arrest + EyeBolts

• Extended DAT Roof Ladder Standard Control Measure Requirements (as per Ladder Hierarchy) As per DAT roof Ladder

• If a LM or ML cannot be used please state here what alternative is to be used, an Eyebolt or other attachment point must be used for all dish installs and all service work.

• 4. If anchor points are needed for Roped Access are they:

  Select Temporary Permenant Structural

  • Temporary
  • Permenant
  • Structural

• 5. On-Site Identified Hazards

• Select if hazard is present:

• Adverser Weather

  Select Control Remove Escalate

  • Control
  • Remove
  • Escalate

• Any Other Hazards ( state what they are below - eg pets, etc)

  Control

  Remove

  Escalate

• Please state here what other hazards are if any?

• Third Parties

  Yes

  No

  N/A

• Traffic

  Control

  Remove

  Escalate

• Existing Equipment

  Control

  Remove

  Escalate

• Garden Hazards

  Control

  Remove

  Escalate

• Ground Hazards

  Control

  Remove

  Escalate

• If Hazard cannot be controlled or removed then they must be escalated. (Give detail)

• 6. Method Statement A clear and detailed method for carrying out the work must be recorded here before the work commences. Additional pages should be added as necessary. Items to be covered include site details; pre-job preparation; type of job (install, service, etc) roof type ( flat, sloping (give approx angle)); rescue considerations ( if standard rescue techniques say so, otherwise specify in detail). the method statement should have sufficient detail to allow another SAT team to understand how they would carry out the work. Draw diagrams if necessary to illustrate. Please write clearly.

• Draw diagrams if necessary to illustrate

  Drawing

• Pictures (if required)

  Media

• Climbing Engineer Signature

  Sign

• Safety Engineer Signature

  Sign

About the Vehicle

• Vehicle Registration

• Vehicle Make and Model

Transfer Details

• Individual handing vehicle over

• Tech Number

• Team

• Individual receiving vehicle

• Tech Number

• Team

• Date transfer took place

  Date

Vehicle Details

• Livery

• Vehicle Mileage

Vehicle Condition

• Is the spare wheel or tyre sealant present

  Yes

  No

  N/A

• Is the Fuel Card present

  Yes

  No

  N/A

• Is there an easi load pole?

  Yes

  No

  N/A

• Is the vehicle damage free?

  Yes

  No

  N/A

• Caddy Only - Are both ladder locks in working order with keys available?

  Yes

  No

  N/A

• Front Of Vehicle

  Media

• Driver's door and wing

  Media

• Driver's side sliding door and rear quarter panel

  Media

• Rear of vehicle

  Media

• Passenger side sliding door and rear quarter panel

  Media

• Passenger door and wing

  Media

• Cab - Driver's side

  Media

• Cab - Passenger's side

  Media

• Signature of Individual 1

  Sign

• Signature of individual 2 if applicable

  Sign

• Manager signature

  Sign

• Date

  Date