HALO INCIDENT REPORT
Halo Location
*
Barrhaven
Kanata
Keswick
London
Orleans
Stratford
Stittsville
Waterloo
Woodstock
Date
*
-
Month
-
Day
Year
Date
Owner Name
*
First Name
Last Name
Are they a Wash Club Member?
*
Yes
No
RFID Tag #
*
Phone Number
*
-
Area Code
Phone Number
Email
*
Vehicle Information
Vehicle Year
*
Vehicle Make
*
Vehicle Model
*
Vehicle Colour
*
Current Mileage
*
License Plate #
*
VIN #
*
Picture of VIN #
*
Browse Files
Cancel
of
Year Vehicle Was Purchased
*
Location Vehicle Was Purchased
*
Damage Information
Time vehicle entered the wash:
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
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40
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49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Is this claim related to paint damage?
*
Yes
No
Description of the claim:
*
Location on the vehicle:
*
Other visible damage:
*
I have read and agree with the information included in this form.
*
Employee Checklist
Take pictures of ALL of the vehicle:
*
Browse Files
Cancel
of
Annotate Image
*
Incident Report Filled out by (Employee Name)
*
Final Decision
*
Please make a note of what the final decision on the claim was.
Submit
Should be Empty: