What this template captures

Fields specific to appliance work — not a generic form.

• Appliance type
• Brand & model
• Serial number
• Previous visit reference
• Symptom reported
• Diagnosis
• Prior issue status
• Maintenance performed
• Installation details
• Repair performed
• Parts / materials replaced
• Warranty on work

Work completed checklist

Tick what you did. Anything unticked stays off the customer's report.

• Symptoms verified
• Diagnostic testing performed
• Serviceable components cleaned
• Appliance operation verified

A finished appliance report

Sample data — this is exactly what your customer receives. The business, customer and address are invented for this example.

ST

Appliance Repair Service Report

Sterling Appliance Repair

(555) 992-5540

service@sterlingappliance.com

sterlingappliance.com

Factory Authorized · Lic #AR-40913

Job #PC-DEMO-8919

Date: August 27, 2026

Tech: Nate Kowalski

Service:Appliance Repair

Work:Repair / reconnection

Customer

Name

Grace Lindqvist

Address

605 Fulton Pl, Minneapolis, MN 55408

Phone

(555) 220-6673

Email

grace.lindqvist@example.com

Appliance details

Location

Kitchen — dishwasher under the counter, left of the sink

Brand & model

Bosch SHXM63WS5N

Appliance type

Dishwasher

Serial number

FD9612 004821

Inspection findings

Observations

Unit drains and completes a full cycle after repair. No leaks at the pump housing under test.

Diagnosis

Drain pump impeller jammed with a glass shard and a clogged check-valve flap. Filter housing also heavily soiled.

Symptom reported

Standing water left in the tub at the end of every cycle and an E24 drain fault on the display.

Work performed

Repair performed

Removed the sump filter, cleared the impeller, cleaned the check valve, replaced the drain pump seal, and reassembled with a new gasket.

Parts / materials replaced

Drain pump seal kit (00611322), sump gasket

Recommendations

Warranty on work

90 days on labor, 1 year on installed parts

Work completed

• Symptoms verified
• Diagnostic testing performed
• Failed component identified
• Part replaced / repaired
• Appliance operation verified

During photos

Captured Aug 27, 2026, 3:45 PM

Technician notes

Work performed

Diagnosed the E24 drain fault, cleared the drain pump and check valve, replaced the pump seal, cleaned the sump filter, and ran two full test cycles with no fault codes or leaks.

Problems discovered

A glass shard had jammed the impeller. Filter had not been cleaned since installation.

Recommended repairs

Rinse the sump filter monthly and run a dishwasher cleaner every three months. Avoid loading broken glassware.

Additional notes

Customer declined the optional rinse-aid dispenser replacement.

Suggested next service: January 1, 1971

Documentation record

Report completed

Aug 27, 2026, 4:30 PM

Technician

Nate Kowalski

Documented by

Sterling Appliance Repair

Photos

1 attached, 1 taken in app

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