Soap Dispenser Maintenance Report
Complete this form to document the inspection and maintenance of a soap dispenser.
Dispenser Location
*
Dispenser ID or Asset Number
*
Type of Soap Dispenser
*
Please Select
Manual
Automatic
Wall-mounted
Countertop
Other
Date and Time of Inspection
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Current Condition of Dispenser
*
Good (No issues)
Minor issues (still functional)
Needs repair
Not working
Issues Found (if any)
Empty or low soap
Clogged nozzle
Leaking
Damaged housing
Sensor malfunction (if automatic)
Other
Maintenance Actions Performed
*
Soap refilled
Nozzle cleaned/unclogged
Parts replaced
Dispenser reset/repaired
No action needed
Other
Amount of Soap Refilled (ml)
Upload Photo of Dispenser (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Technician Name
*
First Name
Last Name
Additional Comments or Notes
Submit Report
Should be Empty: