Cafeteria Services Cleaning Refusal Form
Use this form to formally decline scheduled cleaning services in the cafeteria. Please complete all sections to ensure proper documentation and follow-up.
Full Name of Person Refusing Cleaning
*
First Name
Last Name
Role/Position
*
Please Select
Cafeteria Staff
Manager
Supervisor
Maintenance
Other
Contact Email
*
example@example.com
Cafeteria Location/Building
*
Date of Refusal
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Refusal
*
Hour Minutes
AM
PM
AM/PM Option
Service Area Affected
*
Dining Area
Kitchen
Restrooms
Storage/Pantry
Other
Reason for Refusal
*
Area already cleaned
Area not in use
Event in progress
Rescheduling requested
Other
Preferred Alternative Handling
*
Reschedule cleaning
No cleaning required for this cycle
Contact me to discuss
Other
Additional Comments or Instructions
Signature (Please sign to confirm your request)
*
Submit Refusal
Submit Refusal
Should be Empty: