Leak Report Form
To be completed by Responding Technician
Date
*
-
Month
-
Day
Year
Date Picker Icon
Technician
*
Select One
Amir Dad Hassin
Andy McCann
Christian Artates
Darrin Holoboff
Emmanuel Perron
Howie Ta
Lonny Cluness
Melvin Suyjuarez
Michael Buchan
Mickael Picquet
Rolando Odina
Scott Merriman
Stephane Perron
Thomas Zlotnick
Will Welcher
Yvens Dolcine
Tyler Ashby
David Keogh
Manager
*
Select One
Michael Buchan
Will Welcher
David Lacombe
Customers Name
*
Contact Name
*
First Name
Last Name
Contact E-mail
example@example.com
Contact Phone Number
*
Area Code
Phone Number
Ext
Technician Response
-
Month
-
Day
Year
Date Picker Icon
WO#
Model
*
Serial #
Scan Serial Barcode
Physical Location
Where is the unit located inside the building
Type of Install
Copper
Plastic
If Plastic, fill out type
Black Tubing
White Tubing
Other
Did Customer arrange professional cleaning/remediation services prior to Quench arrival?
Yes
No
Photos Taken?
Yes
No
Upload Photo
Upload a File
Drag and drop files here
Choose a file
- Wide shot of location of leak including: All other equipment that could contribute to damage (refrigerators, ice machines, coffee makers, sinks, etc.) - Damages caused by leak (multiple photos of all damage) - Origin of leak (multiple pictures) - Picture of part that leaked (any serial numbers or parts number markings) - Picture of pressure reducer (if there is one) - Q number of unit - Manufacturer serial number and model number
Cancel
of
Potential Origin of Leak (give description)
Damage caused by leak (give description)
- Specify what items were damaged (such as cabinets, floor, carpet, drywall, ceiling tiles, etc.) - Specify how large of an area was affected by the damage (one room, multiple rooms, a hallway, the floor below, the suite next door, etc.) - Specify if it was just our customers site that was damaged, or other sites as well (such as the suite next door, the suite downstairs, or a shared hallway)
Submitted by
*
Select One
ahassin@quenchwater.com
amccann@quenchwater.com
cartates@quenchwater.com
dholoboff@quenchwater.com
eperron@quenchwater.com
hta@quenchwater.com
lcluness@quenchwater.com
msuyjuarez@quenchwater.com
mbuchan@quenchwater.com
mpicquet@quenchwater.com
rodina@quenchwater.com
smerriman@quenchwater.com
sperron@quenchwater.com
tzlotnick@quenchwater.com
wwelcher@quenchwater.com
ydolcine@quenchwater.com
tashby@quenchwater.com
dkeogh@quenchwater.com
Submit to Manager
Should be Empty: