Airline Crew Cleaning Refusal Form
For crew members to officially document cleaning assignment refusals. Please complete all fields accurately.
Crew Member Full Name
*
First Name
Last Name
Crew Position/Role
*
Please Select
Cabin Crew
Flight Attendant
Purser
Lead Cabin Crew
Other
Employee or Badge Number (non-sensitive)
*
Flight Number
*
Flight Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Route/Sector
*
Cleaning Assignment Area
*
Please Select
Cabin
Galley
Lavatory
Passenger Seats
Other
Reason for Refusal
*
Health or Safety Concern
Insufficient Time
Lack of Proper Equipment
Not Assigned to Area
Other
Please provide additional details (if any)
Supervisor Notified
*
Yes
No
Submit Refusal
Should be Empty: