CODE 4
BIOHAZARD JOB COMPLETION REPORT
Date
/
Month
/
Day
Year
Date
Address
Location
Contact Phone
Drive Time
Rooms/Areas to be Treated
Don/Doff Station
Shift Start
Arrival Time
Departure Time
Shift End
Names, start time, temps, BPs, SpO2s
Names, Break 1 time, temps, BPs, SpO2s
Names, break 2, temps, BPs, SpO2s
Names, finish time, temps, BPs, SpO2s
Wall Type
DRYWALL
PANELING
CONCRETE
OTHER
PAINTED
UNPAINTED
Walls Cleaned
YES
NO
Floor Type
CARPET
VINYL
LINOLEUM
WOOD
CONCRETE
Other
Carpets Cleaned
YES
NO
Hard Surface Furniture Cleaned
YES
NO
N/A
Soft Surface Furniture Cleaned
YES
NO
N/A
Objects Cleaned
YES
NO
N/A
Objects Unable to Clean
YES (list in notes)
NO
N/A
Disinfectant Applied
YES
NO
Were there any areas unable to be treated with Disinfectant
NO
YES (list in notes)
Inhibitor Applied
YES
NO
Were there any areas unable to be treated with Inhibitor
NO
YES (list in notes)
Final Walk Through Done
YES
NO
Locked Up/Notify Client
YES
NO
Any Followup Necessary
YES
NO
Any Notes for Client
YES
NO
Outside Temp
Outside Humidity
Outside Heat Index
Inside Temp
General Notes
Notes for Client
BIOHAZARD JOB COMPLETION REPORT
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