Topic: Maintenance Acknowledgement Form

1.Customer’s Information

Customer Name: __________________

Location: __________________
Contact Person Name: __________________ Telephone No: __________________

2. Product Description

Product Type: Elevator Escalator

Product Model: ___________________
Product Contract No: ___________________

3. Maintenance/Modernization Description

Maintenance reported on: Date__________________ Time: _________________

Preventive Maintenance Corrective Maintenance

4. Maintenance performed by
No. Name Title Signature
1.
2.

5. Problem identified before for the Maintenance and Work carried out
_____________________________________________________________________________________
_____________________________________________________________________________________
6.. Result of the maintenance
_____________________________________________________________________________________
_____________________________________________________________________________________

7.. Customer’s acknowledgement for the maintenance /Modernization Work and related remarks
_____________________________________________________________________________________
_____________________________________________________________________________________
8.. Customer’s Representative

Name: ___________________
Signature:___________________
Date: ___________________