CUSTOMER SITE DETAILS

Site Contact

Site Address

No of AC units ?—Please choose an option—1 AC2 AC3 AC4 AC5 AC

Phone

Email

Preferred Date

Preferred Time

—Please choose an option—07:30 AM - 11:00 AM12:00 PM - 03:30 PM

1. Are you experiencing any issues with your air conditioning system currently?

YesNo

2. Is there anything you need to report prior to the service?

YesNo

3. I confirm that this service is for preventative maintenance only on the air conditioning system and the booking does not include investigation of any faults with the system. I understand this would need to be booked separately as a normal service call.

YesNo

4. Have you been in close contact with anyone who has tested positive to COVID-19 in the past 14 days?

YesNo

5. Have you had any symptoms of COVID-19, such as fever, cough, sore throat, shortness of breath?

YesNo

6. Have you travelled overseas in the past 14 days?

YesNo

Site Specific Information (eg Contact Building Manager 24 hours prior, intercom instruction, access, swipe card or keys required, etc)

SWMS Required

YesNo

Keys Required

YesNo

Are you the Tenant or Owner

TenantOwner

PPE Required

CUSTOMER BILLING DETAILS

Company/Billing Name

Billing Address

Contact Name

Title

Phone

ABN

Email

PO/Work Order

CUSTOMER SITE DETAILS

Site Contact

Site Address

No of AC units

Phone

Email

Preferred Date

Preferred Time

1. Are you experiencing any issues with your air conditioning system currently?

2. Is there anything you need to report prior to the service?

3. I confirm that this service is for preventative maintenance only on the air conditioning system and the booking does not include investigation of any faults with the system. I understand this would need to be booked separately as a normal service call.

YesNo

4. Have you been in close contact with anyone who has tested positive to COVID-19 in the past 14 days?

YesNo

5. Have you had any symptoms of COVID-19, such as fever, cough, sore throat, shortness of breath?

YesNo

6. Have you travelled overseas in the past 14 days?

YesNo

Site Specific Information (eg Contact Building Manager 24 hours prior, intercom instruction, access, swipe card or keys required, etc)

SWMS Required

YesNo

Keys Required

YesNo

PPE Required

CUSTOMER BILLING DETAILS

Company/Billing Name

Billing Address

Contact Name

Title

Phone

ABN

Email

PO/Work Order

CUSTOMER SITE DETAILS

Site Contact

Site Address

No of AC units ?—Please choose an option—1 AC2 AC3 AC4 AC5 AC

Phone

Email

Preferred Day

Preferred Time

—Please choose an option—07:30 AM - 11:00 AM12:00 PM - 03:30 PM

1. Are you experiencing any issues with your air conditioning system currently?

YesNo

2. Is there anything you need to report prior to the service?

YesNo

3. I confirm that this service is for preventative maintenance only on the air conditioning system and the booking does not include investigation of any faults with the system. I understand this would need to be booked separately as a normal service call.

YesNo

4. Have you been in close contact with anyone who has tested positive to COVID-19 in the past 14 days?

YesNo

5. Have you had any symptoms of COVID-19, such as fever, cough, sore throat, shortness of breath?

YesNo

6. Have you travelled overseas in the past 14 days?

YesNo

Site Specific Information (eg Contact Building Manager 24 hours prior, intercom instruction, access, swipe card or keys required, etc)

SWMS Required

YesNo

Keys Required

YesNo

Are you the Tenant or Owner

TenantOwner

PPE Required

CUSTOMER BILLING DETAILS

Company/Billing Name

Billing Address

Contact Name

Title

Phone

ABN

Email

PO/Work Order

CUSTOMER SITE DETAILS

Site Contact

Site Address

No of AC units ?—Please choose an option—1 AC2 AC3 AC4 AC5 AC

Phone

Email

Preferred Day

Preferred Time

—Please choose an option—07:30 AM - 11:00 AM12:00 PM - 03:30 PM

1. Are you experiencing any issues with your air conditioning system currently?

YesNo

2. Is there anything you need to report prior to the service?

YesNo

3. I confirm that this service is for preventative maintenance only on the air conditioning system and the booking does not include investigation of any faults with the system. I understand this would need to be booked separately as a normal service call.

YesNo

4. Have you been in close contact with anyone who has tested positive to COVID-19 in the past 14 days?

YesNo

5. Have you had any symptoms of COVID-19, such as fever, cough, sore throat, shortness of breath?

YesNo

6. Have you travelled overseas in the past 14 days?

YesNo

Site Specific Information (eg Contact Building Manager 24 hours prior, intercom instruction, access, swipe card or keys required, etc)

SWMS Required

YesNo

Keys Required

YesNo

Are you the Tenant or Owner

TenantOwner

PPE Required