Maintenance Request Form - DOC

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					               Maintenance Price/ Evaluation Request Form

Please provide the following information or call us to discuss on Ph 9 545 5755

Company Name:
________________________________________________________________
Address:
________________________________________________________________
________________________________________________ P/code _________
Site contact:
______________________________________Title_______________________
Ph ______________ Fax ________________ Email ______________________

  _____________________________________________________________
                                  Please tick  if relevant
What service programs are you interested in? 
  Visual Service Inspection – VSTR                      Description
  Preventative Maintenance Program – PMP                Description
  Essential Service Program – ESP                       Description
  Just One Program – JOP                                Description
Provide details of suitable access or any site difficulties, OH&S requirements etc
________________________________________________________________
________________________________________________________________

How would you describe access to the equipment?
Meets Australian Standards  Very Safe Acceptable  Requires assessment
 Not safe 
________________________________________________________________
________________________________________________________________
Is there any equipment on a roof? 
Are there fixed ladder access and roof walk ways and barriers installed? 
Is the equipment in a ceiling? 
Do you have fixed ladders and access hatches installed inside? 
Do we require?: Step ladder  or Extension Ladders  Harness’s 

Tell us if any of the mechanical services are out-sourced and already contract Eg
Filter cleaning  Cooling tower Service  Boiler service  Air conditioning 
Refrigeration  Extraction 

Item - __________________Service by _________________Until ___/___/___
Item - __________________Service by _________________Until ___/___/___
Item - __________________Service by _________________Until ___/___/___
Item - __________________Service by _________________Until ___/___/___
Item - __________________Service by _________________Until ___/___/___
Item - __________________Service by _________________Until ___/___/___




Maintenance Price/ Evaluation Request Form
Sovereign Air (Aust) Pty Ltd
                     Maintenance Price/ Evaluation Request Form

      Company Name:
      ___________________________________________
      Address:
      ________________________________________________________________
      ________________________________________________ P/code _________
      Provide a list all equipment:
      Quantity Equipment Eg Split Air conditioner – Capacity/Model 30 kW packaged A/C Location
      Eg Roof, Plant room

QTY      EQUIPMENT                CAPACITY/ MODEL             LOCATION             ACCESS
         MANUFACTURER             Eg Kw or Model #            Eg Roof / Plant      Eg Standards/ Safe/
                                                              Room / Ceiling       Acceptable/ Needs
                                                              Basement             assessment




      Maintenance Price/ Evaluation Request Form
      Sovereign Air (Aust) Pty Ltd

				
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