UFF-Residential Premises Wiring Repair Completion Form V1.1

• Customer Name

• Customer Address
  Address

• Contact Number

• Date and time completed

  Date

• Job ID (AWMS No)

• IM Reference Number

• Description of the work conducted.

• Service Technician Name/s

Work Completed Description

• Work completed description

  Select Residential Premises Wiring-Repair Service Fault

  • Residential Premises Wiring-Repair Service
  • Fault

Work Description

• Describe the work that was carried out.

• Photos of work completed

  Media

• Has there been any changes to the original request

  Yes

  No

• Record any changes from the original request.

• Photograph any changes

  Media

• Fault found at

  Select Jack Point Internal Cabling (Copper) Patchcord ONT Internal Cabling (Fibre) Other

  • Jack Point
  • Internal Cabling (Copper)
  • Patchcord
  • ONT
  • Internal Cabling (Fibre)
  • Other

• If other where is the fault

• Have you made contact with the customer.

  Select Seen Phoned Card Left Left Message No Contact

  • Seen
  • Phoned
  • Card Left
  • Left Message
  • No Contact

• Completion Codes. Please state the codes claimed and the quantity

• Comments

• Service Person's Name

  Sign

• I acknowledge the above service/ has been completed.

  Sign