ALPHA OMEGA RESIDENTIAL SITE REPORT

ALPHA OMEGA RESIDENTIAL SITE REPORT

Copyright 2025 © Electrify EVSE. All rights reserved
CASE NUMBER *
INSTALL TEAM CONTACT INFORMATION *
Any question, Contact 1-888-822-EVSE (3873) / 770-633-0591
SECTION A: SITE INFORMATION

To Field Rep: For Accuracy, please complete prior to scheduled "Site Visit Date"
1a. Site Contact Name (Actual)*
1b. POC Phone Number
Format: (000) 000-0000.
1c. Scheduled Appointment Date (MUST)?*
1d. Scheduled Site Visit Date*

MonthDayYear
1f. Verified EV Charger have been delivered to Site ?*
1e. Scheduled Time*

Must complete Scheduled Time for EVSE to be Ready

AM/PM Option
1g. Have you confirm that EV was available at Site for Charger testing ?
1h. Site Address*
SECTION B: SCOPE OF WORK INFORMATION

To Electrician: Complete this section prior to "Site Visit Date"
1a. Electrician Name*
1b. Electrician Email*
*Manager's email which reviews and approves work performed
2. Task Performed (Click All That Applies for Install ONLY. Service is for after service required)*

Install: EV Charger InstallationInstall: Electrical Cable InstalledInstall: SubpanelInstall: Charger ConfigurationService: CommissionService: Cord ReplacementService: Firmware UpdateService: Incoming PowerService: SIM Card SwapService: TroubleshootService: Removal
3. CONFIRM: You have a clear instructions and download(s) for your assignment? (firmware file, etc.)*
4. Scope of Work (Click each for Confirmation of Understanding)*

1. Review the Scope of Work with Customer2. Scope Installation and Panel Access Areas3. Verify Correct EV Charger4. Install EV Charger5. Connect Proper Cord Length6. Check for Correct Power In/Out7. Test Charger EV (15 min)8. Instruct Customer on Proper Use9. Clean up the Area (leave the Charger Box)10. Checkout - Call In
SECTION C: SCOPE OF WORK PERFORMED & OUTCOME

To be Completed @ the Installation Site by Electrician/Technician
1a. EV Charger Installation Status*
DO NOT SKIP THIS QUESTION: Your Work could be Rejected!
1b. Length of time EV Charged w/ new Charger*
DO NOT SKIP THIS QUESTION: Your Work could be Rejected!

1c. MAJOR Tasks Performed*

Rows	Performed (Check to Confirm)	Task Completed?
Review Scope of Work
Scan the Work Area
Install EV Charger
EV Test Charge (15 min minimum)
Instruct Customer
Clean up the Area

1d. If there are any issues please check all that applies and describe in comment section in detail

Charger Not Installed - POC AbsentCharger Not installed - Faulty ChargerCharger Not installed - Electrical Panel IssuesCharger Not installed - Condition dangerousCharger Not Tested - EV Not AvailableCharger not tested - No ElectricityDangerous site conditionsWeather IssuesBreaker Panel access blockedEmergencies (describe in section 1.a.)Other reasons (describe in section 1.a.)
INSTALLATION DETAILS (If new Breaker/Sub-panel Installation Required, MUST BE permitted by Installation Team)
1. EV Charger Manufacturer, Model# and Serial # Installed during Site Visit*

ManufacturerModel NumberSerial Number
2. If Required, did the Property Owner Obtain City Permit to Install EV Charger?*
DO NOT SKIP THIS QUESTION: Your Work could be Rejected!
3. Actual Location of the Electrical Panel Box*
DO NOT SKIP THIS QUESTION: Your Work could be Rejected!
4. Dedicated Circuit per Port*
DO NOT SKIP THIS QUESTION: Your Work could be Rejected!
5. Actual Length Between Electrical Panel to EV Charger*
DO NOT SKIP THIS QUESTION: Your Work could be Rejected!
6. Did you PERFORM Test Charge/Show how to Use the Charger?*
DO NOT SKIP THIS QUESTION: Your Work could be Rejected!
7. Is New Breaker/Sub-panel required*
STOP: Call 1-888-822-EVSE (3873) / 770-633-0591
8. Describe Existing Panel's Phase, Voltage and Amperage*
INSTALLATION FOLLOW UP DETAILS
1a. CALL 1-888-822-EVSE (3873) / 770-633-0591 to confirm Connected / Commissioned / Active Charger.*
DO NOT SKIP THIS QUESTION: Your Service could be Rejected!
1b. Call in/out Date to be Released*

MonthDayYear
1c. Official Check-Out/Release Time*

For Commissioning and Final Session with EVSE for Release Off the Site Minutes Minutes

AM/PM Option
2. Clear Description of the Activities from Your Visit *
3. If you are returning a defective EV Charger, Type in FedEX/UPS Return Pkg # (take a picture and upload to Section D5)
If no Return Pkg Required, TYPE "No Return #"
Section D. Upload Good Quality Pictures

IMPORTANT: THIS SECTION MUST BE COMPLETED by the Electrician/Technician while at the Service Site
1. IMPORTANT FOR ALL INSTALLATION: Pictures of "Installed New EV Charger - 2 close ups and 2 from distance. ****Must Display Clear & Readable Serial Numbers*****

DO NOT SKIP THIS QUESTION: Your Service could be Rejected!
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2. PICTURES OF: a) Breaker, b) Breaker Panel, c) Crimps, and d) Correctly installed electrical cables.

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3. IMPORTANT - PICTURES OF THE CHARGER WITH BACKGROUND: OF HOUSE OR GARAGE - 2 Pictures (Wide view)*

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4. Screen shot of Active Charger Display and with EV being Charged.*

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5. FEDEX/UPS Return Tracking # Receipt and Other applicable pictures.

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6. POTENTIAL EV/CHARGER MAINTENANCE ISSUE PICTURES - attach any pictures deemed dangerous or needing attention ASAP.

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Signature and Submit Section

IMPORTANT: Signed by electrician/technician who serviced the CASE Ticket(s)
Client/ Site Resident Signature (Use finger of touch screen)*
Electrician/Technician Signature (Use finger of touch screen)Sign to authenticate information provided*
IMPORTANT NOTICE ON SUBMISSION

"FINAL SUBMISSION": Click this button only to submit the completed Installation Request Form to the Install Team. "SAVE ENTRIES": Use this button to save your progress. DO NOT CREATE AND ACCOUNT. Go to bottom and Click "Skip Create an Account". Or, copy the provided link and send to yourself to complete the survey later. "CLICK TO RESET": This will erase all data and references to previous cases, allowing you to start fresh.
Should be Empty:

ALPHA OMEGA RESIDENTIAL SITE REPORT

SECTION A: SITE INFORMATION

SECTION B: SCOPE OF WORK INFORMATION

SECTION C: SCOPE OF WORK PERFORMED & OUTCOME

INSTALLATION DETAILS (If new Breaker/Sub-panel Installation Required, MUST BE permitted by Installation Team)

INSTALLATION FOLLOW UP DETAILS

Section D. Upload Good Quality Pictures

Signature and Submit Section

IMPORTANT NOTICE ON SUBMISSION