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Intake Report Form for In-Shop Work

Intake Information
Brought in by:_______________________ Date:______________________
Time:_______________
Received by:________________________ Phone:______________________
Description of Equipment:________________________________________
Tag Number:___________________ Serial Number:____________________
Description of Problem:_________________________________________________________
_________________________________________________________________

Analysis
Problem as Initially Determined:_____________________________________________________
________________________________________________________________
________________________________________________________________
Proposed Solution:_______________________________________________________
________________________________________________________________

Description of Work Done


Problem as Finally Determined:_____________________________________________________
________________________________________________________________
Work Done:___________________________________________________________

Returned to Customer
Notified to be Picked Up by:_______________ Date:________________ Time:_______________
Picked Up by: ___________________
Date:________________ Time:_______________

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