Proof of Service Delivery
Document Details
Task
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Service Date
16/06/2024
Task Description
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Section A - Customer Details
A1. Company Name
Business Company Inc
A2. What is the Site Address?
1234 Industrial Park Road
Factory Town
FT123
Factory Town
FT123
A3. What is the Order Number?
AB123456789
A4. What is the Account Number?
AB123456789
A5. Is the Billing Address the same as the Site Address?
Yes
A6. If no, what is the Billing Address?
1234 Industrial Park Road
Factory Town
FT123
Factory Town
FT123
Section B - Site Visits
3 Visits
Mon 16th Jun 2024
9:00am - 5:00pm
John Doe
Alex Lyons
Ford Transit Custom AB12 CDE
Mon 16th Jun 2024
9:00am - 5:00pm
John Doe
Alex Lyons
Ford Transit Custom AB12 CDE
Mon 16th Jun 2024
9:00am - 5:00pm
John Doe
Alex Lyons
Ford Transit Custom AB12 CDE
Section C - Work Details
Up to 2500 Litres Tank Empty
Completed Mon 12th Jun at 9:01am
Waste Collection
Completed Mon 12th Jun at 10:15am
Additional Files (Optional)
Shift 12345 - Mon 12th Oct 2024
Shift 23456 - Tue 13th Oct 2024
Shift 62434 - Wed 14th Oct 2024
Confirmation
By signing this document you confirm that:
- You are a responsible representative of the Hirer, authorised to sign on their behalf, and that the service detailed above is correct and the machine has worked to your satisfaction.
- You understand the Hire Charges will be based solely on the agreed hours as signed for.
- All additional Site Rates or Bonuses must be clearly signed or and are chargeable to Hirer's account.
- You acknowledge that the machine(s) are supplied on hire, subject to the Owner's Conditions of Hire, and understand that acceptance of the machine on site implies.
Please Sign Above
Print Name
Johnathan Smith
Date
16/06/2024
POWRA
1. Is this your first job on this site TODAY?
Yes
2. Have you read and understood the Safe System of Work associated with your task?
Yes
3. Do you have enough barriers, signs and cones in place to ensure the safety of you, your vehicle, pedestrians and other road users?
Yes
4. Are you a lone worker?
Yes
5. Is it SAFE to carry out your task(s) as a lone worker?
Yes
6. Are you confident and able to conduct the manual handling tasks associated with this job?
Yes
7. Will you ensure that you maintain good housekeeping before, during, and after the job?
Yes
8. Have you inspected your Tools/Equipment/Vehicle and are they in safe working order?
Yes
9. Is bad weather (heat, cold, snow, ice, or heavy rain) making the job unsafe?
Yes
10. If you are working at height or on the edge of a void, do you have sufficient safety equipment?
Yes
11. Do you have the correct PPE to safely work with Chemicals/Fluid/Oils/Waste?
Yes
12. Do you have hearing protection? (If Required)
Yes
13. Is lighting in the work area sufficient for the task?
Yes
14. Are there any other UNCONTROLLED hazards nearby that could endanger you?
Yes
15. Do you need isolations to carry out your task safely?
Yes
16. Do you have the correct permits/authorisations to start the work?
Yes
17. Have you signed in or made yourself known to site?
Yes
18. Are you undertaking Jetting activities?
Yes
Tank/Cesspit/External Grease Trap Empties
1. Is the job as specified?
Yes
2. Please Take Photograph of inside the Tank before empty
3. Please Take Photograph showing Tank is empty
4. Is this a welfare unit?
Yes
Waste Collection
1. Is the waste as specified?
Yes
2. Select the appropriate Waste description
Yes
3. Quantity of Waste Collected (Litres)
Yes
4. Add photos (Multiple if required)
5. Are you collecting any more waste on this job?
Yes
Job Sign Off (New)
Is there a representative avaliable to sign off the work?
Yes
Is this job complete?
No
Were any concerns/issues raised?
No
Print Name
Johnathan Smith
Date
16/06/2024
Created by Teamleaf
Generated on Mon 17th Jun 2024, Scan QR Code for Task Information