Mattress Condition Assessment Form
Evaluate the current condition, comfort, cleanliness, and replacement need for a mattress.
Mattress Age (in years)
*
Mattress Type
*
Please Select
Innerspring
Memory Foam
Latex
Hybrid
Airbed
Other
Overall Physical Condition
*
1
2
3
4
5
Comfort and Support Level
*
Very Uncomfortable
1
2
3
4
Very Comfortable
5
1 is Very Uncomfortable, 5 is Very Comfortable
Cleanliness and Hygiene
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Defects or Issues Present
*
Sagging
Broken springs
Tears or holes
Stains
Odors
None
Other
Detailed Assessment Table
*
Rows
Excellent
Good
Fair
Poor
Surface evenness
1
2
3
4
Edge support
5
6
7
8
Noise level
9
10
11
12
Odor presence
13
14
15
16
Frequency of Mattress Use
*
Every night
Several times a week
Occasionally
Rarely
Accessories Used
Mattress protector
Topper
None
Other
Recommendation
*
Retain
Replace soon
Immediate replacement needed
Submit Assessment
Should be Empty: