STEP 2 · STATUTORY DELIVERABLE
Repair Visit Closeout Record
—
Draft · Not an official record
Closeout determination
Checklist complete—
Open issues—
Part decisions—
Appliance & visit
| Customer | — |
|---|---|
| Service address | — |
| Appliance | — |
| Model | — |
| Serial | — |
| Visit date | — |
| Reported symptom | — |
Part cross-reference
| Removed part | — |
|---|---|
| Installed part | — |
| Fit basis | — |
| Quantity | — |
| Part unit price | — |
| Labor charge | — |
| Diagnostic / trip fee | — |
Closeout checklist evidence
| Check | Stage | Status |
|---|---|---|
| Diagnosis confirmed | Visit | — |
| Fault isolated to component | Visit | — |
| Replacement part decided | Part | — |
| Part sourced & on hand | Part | — |
| Repair performed | Part | — |
| Post-repair function test | Part | — |
| Electrical & safety check | Part | — |
| Work notes recorded | Sign-off | — |
| Customer approved estimate | Sign-off | — |
| Invoice line items entered | Sign-off | — |
Before invoicing
| Checklist | — |
|---|---|
| Part decisions | — |
| Sign-off | — |
Technician sign-off
| Technician | — |
|---|---|
| Signed off | — |
| Date | — |
Technician notes & exceptions
| Exceptions | — |
|---|---|
| Notes | — |
Customer acknowledgment
Date
Assumptions & safety
This record documents the decisions made during the visit as entered by the technician. Technicians must verify manufacturer cross-references, part fit, electrical and gas ratings, and installation requirements. It does not replace manufacturer service information, safety procedures, code requirements, or warranty authorization. Final installation and energization remain the technician’s responsibility. Amounts are shown as entered and are not totaled or taxed here.
Prepared with Appliance Repair Closeout