Need assistance?
Technical Support:
Startup/Field Service:

Request Signify Lighting Systems Field Services

Please complete this form to request field services for Signify Lighting Systems products.
Signify Lighting Systems field services services are scheduled on a first come, first served basis. Three to four weeks notice is advised for booking services. For requests made within two weeks of service date, additional charges may apply.

* denotes required fields
*Project Name:
Site Address:
Province (International):
Postal Code:
*Service Type:
*Partial or Complete Job?
*Signify Product Type:
Sales Order Number:
*Purchase Order Number:
*Preferred Start Date for Service:
*Alternate Start Date for Service:
*Requested Turnover Date:

Notes: (1000 character maximum)

Requestor Information
*Requestor Name:
Contractor Information
Check here if same as requestor information
*Installing Contractor:
*Contractor Contact Name:
Distributor/Dealer Information
Check here if same as requestor information
*Distributor/Dealer Contact Name:
Jobsite Contact Information
Check here if same as requestor information
*Contact Name:
Customer Representative Information
*Customer Representative Name:
*Is a site safety course required?
If yes, list safety course time and location:
*Is specialized Personal Protective Equipment (PPE) required (other than safety toe shoes, glasses, hard hat, and reflective vest)?
If yes, please list additional Personal Protective Equipment (PPE) required.
*What are typical working hours for this jobsite?
Is work permitted beyond typical working hours? Please explain any limits on working hours.
*Are there any specific permit, clearance, insurance, or other requirements to access jobsite?
If yes, please list all requirements for jobsite access.
*Is all system equipment accessible?
*Will any third party programmers be on site at the time of this visit?
By submitting this request for field service, I attest that all information provided in this form is correct. I also understand that if the Field Service Representative arrives at the date and time requested and the site is not ready for field service, additional costs may be incurred and that an additional purchase order to Signify will be required to schedule additional time onsite or a return visit.
*Please Initial Here
Signify Field Service Representative Scope of Work:
Field Service Representative will only be able to:
  - Ensure that the system was properly installed and functions correctly, including trouble-shooting and providing guidance to the contractor to correct any problems.
  - Train personnel in the operation of the Lighting Control System.
  - Set parameters as detailed in the OPR, BOD, Specifications, or approved submittal provided to Signify.
Field Service Representative will NOT be able to:
  - Install equipment or make electrical connections required of the installing contractor, including Power, Class 1 and Class 2 Control wiring, and/or any other connections that require a licensed electrician.
  - Return to instruct any personnel who missed the original training session.
  - Return to change parameters not detailed in the OPR, BOD, or Specifications provided to Signify.

I understand the scope of work for the Signify Field Service Representative
*Please Initial Here

blue line