Document No: IOM-002
Issue Date:
24/09/2020
Revision:
6
Page:
42 of 42
Unrestricted
10
CUSTOMER COMMENTS/FEEDBACK
Please complete the Sign Off section at the bottom of form to confirm each page of this document
has been read and complied with in full.
Originator Name and Initials (BLOCK CAPITALS)
Date
Contact Details
Contact Details
Project Reference
Customer
Region
Product Type
Part Number (P/N)
Serial Number (S/N)
Please enter details below e.g. comments; complaints; evidence of good practice; incident
reports; observations and recommendations, including any associated with health, safety or the
environment, etc., also include any names/contact details of other relevant personnel.
Sign Off Section
Name (BLOCK CAPITALS)
Signature
Date
Please e-mail completed form to the Product Safety Officer at the following address: