Repair Evaluation Form Use this for Service Repair Evaluation CompanyDate Date Format: MM slash DD slash YYYY Time : HH MM AM PM Contact Person* First Last Authorizing Person (Owner, Manager, Supervisor)Address* Site Identification (state where the unit is located) Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Section BreakAccessibility*Steps required to physcially work on unit. Location of AH (Inside) UnitLocation of Condenser (Outside) UnitDistance Between Units*Measured Amount of feet and inches between Inside and Outside UnitConstraintsRoof PenetrationElectrical ClearanceVoltage*Air HandlerVoltageCondenser EquipmentEquipment and Tool Rental anticipated to complete installationSection BreakLoad DensityMeasurements to creat Heat Load CalculationSpecial ConsiderationAnything not listed on form but pertinent to jobHours Required for service*Parts List*MakeModelSerialQtyPart Description File UploadPicture, Drawings, anything pertinent to be reiviewedCommentsThis field is for validation purposes and should be left unchanged.
