Borehole Maintenance Contract Report Form
Submit detailed records of borehole maintenance contract activities and outcomes. Please complete all relevant fields accurately.
Contract Reference Number
*
Borehole Location
*
Date of Maintenance
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Maintenance Activity Performed
*
Please Select
Routine Inspection
Pump Servicing
Cleaning/Flushing
Repairs
Water Quality Testing
Other
Outcome / Result
*
Please Select
Operational
Requires Follow-up
Parts Replaced
Major Issue Found
Other
Technician/Engineer Name
*
First Name
Last Name
Contact Email
example@example.com
Additional Comments or Notes
Signature (Confirmation of Report)
*
Submit Report
Submit Report
Should be Empty: