SW001: F&G Access Route Survey Form 201124

• Conducted on

  Date

• Prepared by

• Dealer Name

• Site Name

• Site Number

• Site Address

• Key Contact Name

• Key Contact Position

Current Unit

• Unit for disposal?

  Yes

  No

  N/A

• Equipment Type

  Select Cabinet Counter Blast Chiller Undercounter Prep Multideck Bottle Cooler Ice-Machine Other (add to notes)

  • Cabinet
  • Counter
  • Blast Chiller
  • Undercounter
  • Prep
  • Multideck
  • Bottle Cooler
  • Ice-Machine
  • Other (add to notes)

• Brand/Manufacturer

• Model

• Dimensions (WxDxH)

• Serial Number

• Estimated Age (years)

• Condition

  Good

  Fair

  Poor

  N/A

• Foster Equivalent (Model & Device Code)

• Additional Notes

• Have you discussed with the key contact, their responsibilities in ensuring the unit is outside and ready?

  Yes

  No

  N/A

• Foster Model

• Additional Notes

Access Point

• Details

Additional Notes

• Further site requirements

• Discussed any relevant site responsibilities with key contact?

  Yes

  No

  N/A