Post-Repair Appliance Checkoff Form

Post-Repair Appliance Checkoff Form
Complete this form to verify appliance repairs and ensure quality before closing the service call.
Customer Name
First NameLast Name
Customer Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Service Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Repair
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Appliance Type
Appliance Make/Model
Appliance Serial Number (if available)
Repairs Performed (select all that apply)
Other
Post-Repair Functional Checks
Rows Pass Fail N/A
Power On
Cycle/Program Runs
No Unusual Noise
No Leaks/Drips
Safety Features Working
Additional Notes or Recommendations
Customer Satisfaction Confirmation
Technician Name
Technician Signature (Required)
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