Damaged Pole Form
(form 5.5)
Please fill out this form if you find any units have been damaged that you are unable to repair on the spot.
Date
*
-
Day
-
Month
Year
Date
Service Technician: (please select)
*
Please Select
Cameron Fox
Chris Holwell
Don Mossuto
David Tierney
Oz Bin Cleaning WA
Oz Bin Cleaning NSW
OZ Bin Cleaning QLD
Oz Bin Cleaning SA
Other
Customers name:
*
Customers Site name if different:
Site address:
*
Damaged Unit Details
Bar-code No. #1
*
Location Details #1
*
Detail damage
Action Required
Additional Comments
Attach images
Select File
Cancel
of
Submit
Should be Empty: