Retail Associate Cleaning Refusal Form
Retail Associate Cleaning Refusal Form
Cleaning Task Description
*
Reason for Refusal
*
Insufficient supplies or equipment
Time constraints or scheduling conflict
Task outside job responsibilities
Area inaccessible or unsafe
Other (please specify)
Store or Area Location
*
Date and Time of Refusal
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Was a supervisor or manager notified?
*
Yes, supervisor notified
Yes, manager notified
No, not notified
Name of Person Notified
Follow-up Action Taken or Needed
Submit
Should be Empty: