Close Out Form

Required fields are marked with (Required), these fields must be completed to submit the form.
A closeout code will be sent by your Prodco support rep once they have reviewed the submitted form.
Please stay on site until your closeout code has been sent.

Visit Details
Work Order Number(Required)
Visit Date(Required)
MM slash DD slash YYYY
Tech Time In(Required)

: Hours

Minutes

AM/PM
Tech Time Out(Required)

: Hours

Minutes

AM/PM
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Prodco Support Rep
Name
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Support Log Time In

: Hours

Minutes

AM/PM
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Support Log Time Out

: Hours

Minutes

AM/PM
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Did tech leave site during job?
- No
- Yes
Reason tech left site(Required)
Tech Time In 2(Required)

: Hours

Minutes

AM/PM
Tech Time Out 2(Required)

: Hours

Minutes

AM/PM
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Support Log Time In 2

: Hours

Minutes

AM/PM
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Support Log Time Out 2

: Hours

Minutes

AM/PM
Your Name(Required)
First Last
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Tech Group(Required)
Select your tech group
Standard Photos
You do NOT need to send photos that have already been sent to your Prodco support rep.
Photo(s) must be fully uploaded before submitting form.
Entrance:
– Wide angle photo of each entrance, looking from inside out, floor to ceiling. (sensor must be visible)
Sensor properly mounted:
– Close up of installed sensor at an angle
Network Switch:
– Wide angle of rack or network area
– Close up of switch being used
– If POE Injector is not in use, include a photo of where it is being left at the network area.
Return Package: (if there is hardware being returned)
– Items in box being returned
– Box with tracking label on it ready to be shipped out (Leave with GC or MOD)
Drop files here or

Max. file size: 1 GB.
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Entrance Photos
Wide angle photo of each entrance (floor to ceiling), sensor must be visible in photo.
Drop files here or

Max. file size: 1 GB.
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Network Switch
Picture of network switch location or POS Location.
Drop files here or

Max. file size: 1 GB.
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Sensors Mounted Properly
Close up photo of sensor from an angle
Drop files here or

Max. file size: 1 GB.
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Photo of return package
If a return is needed, photo should show returned package with tracking label on it
Drop files here or

Max. file size: 1 GB.
Sign Off
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Support Return Package Acknowledgement
- None
- Left on Site
- Return Package
Return Package Consent(Required)
The package is being left on site and it has been handed over to the Manager or GC listed below.
Onsite Manager/GC Phone
Onsite Manager/GC Email(Required)
Onsite Manager/GC Confirmation(Required)
First Last
Onsite Manager/GC Signature(Required)
Responsible for return package and/or remaining hardware on site. To hand over on store turn over, if store is not yet opened. Will hand off to shipping company on next pickup/drop off visit, or drop off at shipping company drop box.
Onsite Manager/GC Signature(Required)
Responsible for hardware left on site. To hand over on store turn over, if store is not yet opened.
Onsite Manager/GC Signature
Your Email
For a copy of this form
Your Signature
Checkout Code
Email
This field is for validation purposes and should be left unchanged.

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