Worksheet #790314 – NS Services Forms

Title *

Content

Admin Notes

Engineer's Name

Assigned Engineer

Admin/accounts can assign or change the engineer for this job.

Clearance Certificate

Site Name

Loaded from the selected customer’s saved site names.

Date

Person in Charge (Contractor Supervisor)

Number of Workers

Description of Work

Is The Work (See Guidlines)

Medium Risk If YES, what is the Safety Method Statement Number
Low Risk

Safety Method Statement

Are isolation procedures required?

Yes
No

Before Work Commences

Customer Representative

As the contractor I confirm that I will carry out work as agreed

Yes

Date

On behalf of the site, I have reviewed and agree to these work arrangements

Yes

Date

Checklist (Tick as Required

Clearance Certificate fully completed

Safety Method Statement available (Med Risk Only)

Have you signed the customers register prior to commencing work?

Work Completed Safely

Customer Representative

Position Within Retailer

Retailer Signed

Yes

Date

Comments

Checklist (Tick as Required)

Certificate signed by Contractor/Retailer

All obvious hazards identified and precautions taken

Did a near miss occur whilst on site?

Machine Type

Job No.

Date

Job Type

Client

Address

Auto-populates from the selected customer site where possible.

Travel Time

Time Work Began

Time Work Finished

Total Time on Site

Call Instruction Recieved

Report of Fault Found

Report of Work Carried Out

Machine Working on Arrival

Y
N

Machine Working on Departure

Y
N

Return Visit Required

Y
N

Parts Used

1

Qty

Part No.

Start typing a part number or description. Selecting a known part auto-fills the description, but you can still type manually.

Description

Auto-filled when a matching part is selected, but can still be edited manually.

Add Row

Chargeable Call Please Tick Box

Accident Damage
Non Contract Work
Vandalism
Daily Care Not Carried Out

Number of Workers

CUSTOMER Signature

Customer signs in the signature box shown on the job sheet.

Validate Email