Free Cleaning Services Health Assessment Form Template

Cleaning Services Health Assessment Form

This form is designed to ensure that we have a comprehensive understanding of your cleaning requirements, property details, and any health considerations that may impact our cleaning process. By completing this form, you enable us to deliver personalized cleaning services that not only meet but exceed your expectations while ensuring the well-being of all occupants.

Client Information:

Name:

[Client Name]

Company/Organization:

Contact Number:

Email Address:

Address:

Property Information:

Property Type:

  • Residential

  • Commercial

  • Industrial

Size of Property:

Number of Rooms/Spaces:

Special Instructions:

Cleaning Requirements:

Frequency of Cleaning:

  • Daily

  • Weekly

  • Bi-weekly

  • Monthly

  • One-time service

Cleaning Services Needed (check all that apply):

  • Dusting and Wiping Surfaces

  • Vacuuming and Mopping Floors

  • Bathroom Cleaning and Sanitization

  • Kitchen Cleaning

  • Window Cleaning

  • Carpet Cleaning

  • Upholstery Cleaning

  • Other (please specify):

Additional Services (if needed):

  • Disinfection Services

  • Deep Cleaning

  • Post-Construction Cleaning

  • Move-in/Move-out Cleaning

  • Special Event Cleaning

  • Other (please specify):

Health and Safety Assessment:

  1. Does anyone in the property have any allergies or sensitivities to cleaning products?

  • Yes

  • No

  • If yes, please specify: [Details]

  1. Are there any specific health concerns or conditions we should be aware of before conducting cleaning services?

  • Yes

  • No

  • If yes, please specify: [Details]

  1. Is there anyone in the property with compromised immune systems or respiratory issues?

  • Yes

  • No

  • If yes, please specify: [Details]

  1. Are there any pets in the property?

  • Yes

  • No

  • If yes, please specify: [Details]

Declaration:

By signing below, I confirm that the information provided in this form is accurate to the best of my knowledge. I understand that [Your Company Name] will use this information to tailor cleaning services to meet my specific needs and ensure the health and safety of all occupants.

Client Signature:

Date:                               


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