Report ID#

Service Date

Company

Contact

Address

Battery Type

Battery Capacity

Battery Serial #

Battery Usage and Condition

A.H. Capacity

Voltage

Type of Lift Truck (Make / Model)

Number of Batteries per Truck

Number of Shifts Truck is Used per Day

Number of Days per Week Truck is Used

Tray Condition

Connector Condition

Checkboxes

Clean

Dry

Leakers

Battery's General Appearance

Electrolyte Levels

Intercell Connectors' Condition

Cable Condition

Battery Charger & Condition

Charger Manufacturer

Charger Type

HIGH-FREQ

FERRO

SCR

OTHER

Type of Charging

Conventional

Opportunity

Fast

Rapid

Charger Model

Individual Cell Readings

Are Cell Readings Taken While Battery is in Lift Truck?

Yes

No

Battery Voltage

Cell 1OCV

Cell 1OCS

Cell 1OnCV

Cell 1OnS

Cell 1Temp

Cell 2OCV

Cell 2OCS

Cell 2OnCV

Cell 2OnS

Cell 2Temp

Cell 3OCV

Cell 3OCS

Cell 3OnCV

Cell 3OnS

Cell 3Temp

Cell 4OCV

Cell 4OCS

Cell 4OnCV

Cell 4OnS

Cell 4Temp

Cell 5OCV

Cell 5OCS

Cell 5OnCV

Cell 5OnS

Cell 5Temp

Cell 6OCV

Cell 6OCS

Cell 6OnCV

Cell 6OnS

Cell 6Temp

Special Comments

Dealer

Field Tech

Person Seen

Customer Name/Signature

Travel Time in hours

Status