Housekeeping Service Refusal Form
Please complete this form to document the refusal of housekeeping service by a guest. All fields are required for accurate record-keeping.
Guest Full Name
*
First Name
Last Name
Room Number
*
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
Staff Member Recording Refusal
*
First Name
Last Name
Method of Refusal
*
In person
Phone
Written note
Other
Reason for Refusal
*
Please Select
Do not disturb
Guest prefers to clean own room
Not needed today
Illness or rest
Other
Is the refusal temporary or ongoing?
*
Temporary (single day)
Ongoing (multiple days)
If ongoing, please specify duration (dates or number of days)
Additional Housekeeping Instructions or Notes
Signature of Staff Member
*
Submit Refusal
Submit Refusal
Should be Empty: