Drain Cleaning Form
Checklist for drain inspection and cleaning operations
Date of Service
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Service Address or Location
*
Drain Type
*
Please Select
Kitchen Sink
Bathroom Sink
Floor Drain
Toilet
Bathtub/Shower
Outdoor Drain
Other
Blockage Severity
*
None
Minor
Moderate
Severe
Symptoms Observed
Slow Drainage
Standing Water
Odor
Gurgling Sounds
Overflow
Other
Cleaning Method Used
*
Please Select
Manual Removal
Plunger
Drain Snake
Hydro Jetting
Chemical Treatment
Other
Tools/Equipment Used
Gloves
Drain Auger
High-Pressure Jet
Camera Inspection
Plunger
Other
Is Follow-Up Required?
*
Yes
No
Completion Status
*
Completed
Partially Completed
Not Completed
Additional Notes or Observations
Submit Checklist
Should be Empty: