Xerox FaxCentre F110, Service Manual

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Form EH&S-700 (08Nov2000)
Product Description
Model No. or Product name :
Product Serial : Serial Number(s) of Accessory (ies):
Installation Date: Total Copy Meter :
Date of last service maintenance :
List damaged and affected part(s) of the machine by description and part number :
Description Part Number
Location of product and affected part(s):
Individual Providing Notification
Name :
Title :
Telephone Number :
Organization : E-Mail:
Mailing Address : Date Report Submitted :
Instructions: E-mail or fax this completed form to EH&S:
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For incidents in Xerox Europe and Developing Markets East
(Middle East, Africa, India, China, and Hong Kong)
please
e-mail: Elaine.Grange@gbr.xerox.com or fax : +44 (0) 1707 35 3914 [intelnet 8*668 3914]
Note: - If you fax this form, please also send original by internal mail
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For incidents in North America and Developing Markets West
(Brazil, Mexico, Latin American North and Latin American South)
please
e-mail : Doris.bush@usa.xerox.com or fax 585-422-6449 [Intelnet 8*222-6449]