Handicare C1000 - Page 30

C1000 - User Guide (636155) Rev: 04 Nov 2019 Page: 30
Service Record History
Complete this section after each service, repair inspection and/
or maintenance. Photocopy additional pages as required.
Service Type: □ Periodic Inspection □ Monthly Inspection □ 6 Month Inspection □ Repair □ Yearly Inspection □ Other:_________
Completed By: _________________________ _____________________________
Printed Name Signature
Company:
_____________________________________________________________
Remarks & Action Taken:
Date: _______________________ Time: ________________________
Service Type: □ Periodic Inspection □ Monthly Inspection □ 6 Month Inspection □ Repair □ Yearly Inspection □ Other:_________
Completed By: _________________________ _____________________________
Printed Name Signature
Company:
_____________________________________________________________
Remarks & Action Taken:
Date: _______________________ Time: ________________________
Service Type: □ Periodic Inspection □ Monthly Inspection □ 6 Month Inspection □ Repair □ Yearly Inspection □ Other:_________
Completed By: _________________________ _____________________________
Printed Name Signature
Company:
_____________________________________________________________
Remarks & Action Taken:
Date: _______________________ Time: ________________________
Service Type: □ Periodic Inspection □ Monthly Inspection □ 6 Month Inspection □ Repair □ Yearly Inspection □ Other:_________
Completed By: _________________________ _____________________________
Printed Name Signature
Company:
_____________________________________________________________
Remarks & Action Taken:
Date: _______________________ Time: ________________________
Service Type: □ Periodic Inspection □ Monthly Inspection □ 6 Month Inspection □ Repair □ Yearly Inspection □ Other:_________
Completed By: _________________________ _____________________________
Printed Name Signature
Company:
_____________________________________________________________
Remarks & Action Taken:
Date: _______________________ Time: ________________________
Service Type: □ Periodic Inspection □ Monthly Inspection □ 6 Month Inspection □ Repair □ Yearly Inspection □ Other:_________
Completed By: _________________________ _____________________________
Printed Name Signature
Company:
_____________________________________________________________
Remarks & Action Taken:
Date: _______________________ Time: ________________________