Information
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Account Name (enter in CAPS please)
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Account #
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SiteID
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Contact
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Location
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Phone Number
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email Address
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Conducted On
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Prepared By
- Butch Light
- Carl Popkes
- Chris Hayes
- Chris Zimmerman
- Dan Volker
- David Birchett
- James Korfas
- Justin Casto
- Jason Roberts
- Jerry Jimene
- Jim Foley
- John Lockwood
- Kevin Rowland
- Mac Rivenbark
- Mark Westervelt
- Seamus Daley
- Scott Murphy
- Tod Bierling
- Michael Martin
- Reg Steele
- Greg Watson
- Greg Gildea
- Mike Davenport
- Mike Gruielich
- Michael Dutcher
- Bob Murphy
- Dave Goodwin
- Keith Segrue
- Jay Feilen
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Enter your name if not listed
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Is this still a current Swisher account ?
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Type of Account?
Dishmachine Process Area
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Insert a Picture of the Dishmachine and the Area around it
Dishmachine General Info
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Enter Other make or N/A if there is no dish machine.
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Enter dishmachine make / name
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Model
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Voltage
Dishmachine Chemistry
Dispensers
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Warewash control system
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Enter Dispenser make / name
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Encapsulated / Solid Bowl
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Enter bowl make / name
Products / Titrations
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Dishmachine Water Hardness
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Water Softener system checks
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Was Repair Completed
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Dishmachine Detergent
- Swisher Bio-Clean
- Swisher Extra Strength Plus
- Swisher Liquid Metal Safe
- Swisher Meta Safe
- Swisher Multi-Temp Detergent
- Swisher Power Clean
- Swisher Sparkle Dish Machine Detergent
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Titration / Volume / ml/rack
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Was an adjustment required?
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Enter adjusted Titration / Volume / ml/rack
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Dishmachine Rinse Additive
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Titration / Volume / ml/rack
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Was an adjustment required?
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Enter adjusted Titration / Volume / ml/rack
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Dishmachine Sanitizer
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Titration / Volume / ml/rack
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Was an adjustment required?
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Enter adjusted Titration / Volume / ml/rack
Dishmachine Inspection
Machine Controls
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Pre Wash Temperature
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Was Repair Completed
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Wash Tank Temperature
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Was Repair Completed
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Power Rinse Temperature
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Was Repair Completed
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Final Rinse Temperature
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Was Repair Completed
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Final Rinse Pressure
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Was Repair Completed
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Fresh Water Feedback
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Was Repair Completed
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Energy Saver
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Was Repair Completed
Mechanical Operation
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Fill Valve
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Was Repair Completed
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Cam Timer
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Was Repair Completed
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Micro switch
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Was Repair Completed
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Wash Arms
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Was Repair Completed
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Rinse Arms
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Was Repair Completed
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Rinse arm thumb screw
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Was Repair Completed
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Final Rinse Jets
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Was Repair Completed
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Final Rinse Solenoid
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Was Repair Completed
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Overflows
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Was Repair Completed
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Drain Valves
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Was Repair Completed
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Conveyor Belt / Chain
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Was Repair Completed
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Conveyor dog
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Was Repair Completed
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Curtains
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Was Repair Completed
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Racks
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Was Repair Completed
Chemical Delivery
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Foot Valves
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Was Repair Completed
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Chemical pick up tubing
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Was Repair Completed
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Squeeze tubes
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Was Repair Completed
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Encapsulated / Detergent bowl
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Was Repair Completed
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Feed tubing to machine
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Was Repair Completed
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Detergent injection fittings
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Was Repair Completed
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Rinse injection fitting
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Was Repair Completed
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Sanitizer injection fitting
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Was Repair Completed
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Vacuum breaker
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Was Repair Completed
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Water solenoid
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Was Repair Completed
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Saddle valve
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Was Repair Completed
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Control Board
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Was Repair Completed
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Wall Brackets
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Was Repair Completed
Signage
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Wall Chart
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Was Repair Completed
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Dispenser Product Stickers
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Was Repair Completed
Operator Procedures
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Racking
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Was Training Provided?
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Prescrapping
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Was Training Provided?
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Presoaking
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Was Training Provided?
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Deliming
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Was Training Provided?
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Curtain Cleaning
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Was Training Provided?
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Tank Water Change / Fill
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Was Training Provided?
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Scrap Tray Cleaning
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Was Training Provided?
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Equipment Cleaning
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Was Training Provided?
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Sanitizer Level checked?
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Was training and or test strips provided?
Dishmachine Current Results
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Water / Ice Tea Glasses
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Describe
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Stemware
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Describe
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Plates and Saucers
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Describe
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Cups and Bowls
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Describe
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Flatware
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Describe
Presoak Process Area
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Insert a Picture of the Presoak Area
Presoak General Info
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Presoak Dispenser Model
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Enter dispenser make / name
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Presoak Product
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oz./gal dispensed
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Was an adjustment required?
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Enter the adjusted titration / oz/gal
Presoak Inspection
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Chemical Pick up tubing
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Was Repair Completed
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Feed Tubing
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Was Repair Completed
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Foot Valve
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Was Repair Completed
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Water Line
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Was Repair Completed
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Wall Brackets
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Was Repair Completed
Signage
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Dispenser Product Stickers
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Was Repair Completed
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Wall Chart
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Was Repair Completed
Pot & Pan Three Sink Process Area
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Insert a Picture of the Three Compartment Sink Area
Pot & Pan Three Sink General Info
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Pot & Pan Dispenser Model
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Enter Dispenser name / make
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Pot & Pan Product
- Swisher Aurora Blue
- Swisher Bartender
- Swisher Economy Pink Pot and Pan
- Swisher Low Foam
- Swisher Lust H/D Pink
- Swisher OCP Solid Pot and Pan
- Swisher Platinum
- Swisher Power Pot and Pan
- Swisher Select HD Lemon Pot and Pan
- Swisher Sunshine
- Swisher Super B
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oz./gal dispensed
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Was an adjustment required?
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Enter adjustment titration / oz/gal
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Third Sink Sanitizer Dispenser
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Sanitizer Product
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ppm level
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Was an adjustment required?
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Enter adjustment ppm
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Did operator test sanitizer level?
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Was Training Provided?
Pot & Pan Inspection
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Dispenser
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Was Repair Completed
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Chemical pick up tubing
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Was Repair Completed
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Feed tubing to sinks
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Was Repair Completed
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Foot Valves
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Was Repair Completed
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Water valve connections
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Was Repair Completed
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Saddle valve
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Was Repair Completed
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Wall Brackets
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Was Repair Completed
Signage
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Wall Chart
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Was Repair Completed
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Wash/Rinse/Sanitizer Stickers
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Was Repair Completed
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Fill to this Line Stickers
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Was Repair Completed
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Dispenser Product Stickers
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Was Repair Completed
Pot and Pan Current Results
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Pots and Pans
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Describe
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Dishes
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Describe
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Food Preparation Surfaces
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Describe
Kitchen Ancillary Process Area
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Insert a Picture of the Ancillary Kitchen Area
Kitchen Ancillary General Info
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Ancillary Dispenser Model
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Enter dispenser make / name
Glass Cleaner Product
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Swisher Glass Kleen
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Tip Color and oz./gal dispensed
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Swisher Ultra Glass Cleaner
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Tip Color and oz./gal dispensed
APC Product
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Swisher Brisa General Purpose Cleaner
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Tip Color and oz./gal dispensed
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Swisher Citrus Plus
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Tip Color and oz./gal dispensed
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Swisher OCP Hi-Ox
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Tip Color and oz./gal dispensed
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Swisher Pine Plus
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Tip Color and oz./gal dispensed
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Swisher Ultra Citrus Neutral
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Tip Color and oz./gal dispensed
Floor Cleaner Product
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Swisher EZ Floor Cl
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Tip Color and oz./gal dispensed
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Swisher Quarry Tile Floor Cleaner
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Tip Color and oz./gal dispensed
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Swisher Ultra Quarry Tile Floor Cleaner
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Tip Color and oz./gal dispensed
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Swisher Wash N Go
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Tip Color and oz./gal dispensed
Degreaser Product
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Swisher Hercules
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Tip Color and oz./gal dispensed
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Swisher Neon - Spray Cleaner / Degreaser
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Tip Color and oz./gal dispensed
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Swisher Purple Mean Clean
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Tip Color and oz./gal dispensed
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Swisher Red - Degreaser
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Tip Color and oz./gal dispensed
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Swisher Synplex Steam Clean Compound
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Tip Color and oz./gal dispensed
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Swisher Ultra Degreaser
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Tip Color and oz./gal dispensed
Other Products Installed
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Swisher Odor-Kleen
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Tip Color and oz./gal dispensed
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Swisher Ultra Air Freshener-Fresh Linen
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Tip Color and oz./gal dispensed
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Swisher Ultra Air Freshener-Mango
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Tip Color and oz./gal dispensed
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Swisher Yellow - Odor Neutralizer
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Tip Color and oz./gal dispensed
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Swisher Bathroom Kleen
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Tip Color and oz./gal dispensed
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Swisher Tub & Tile Kleen
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Tip Color and oz./gal dispensed
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Swisher Ultra Tub & Tile
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Tip Color and oz./gal dispensed
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Swisher Lemon Kleen Disinfectant
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Tip Color and oz./gal dispensed
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Swisher Nutra Bac
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Tip Color and oz./gal dispensed
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Swisher Ultra Disinfectant
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Tip Color and oz./gal dispensed
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Swisher Ultra Non-Acid Bathroom Cleaner
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Tip Color and oz./gal dispensed
Regulatory Compliance
Regulatory Items
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MSDS on location for all products
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Discussed with customer
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Follow Required:
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MSDS Book/Station
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Discussed with customer
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Follow Required:
Opportunities - Programs
Select Swisher programs that can be sold into this account.
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Warewashing Program
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Enter estimated weekly revenue dollars $
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Swisher Total Image
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Enter estimated weekly revenue dollars $
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Paper (towel, tissue, seat covers, etc.)
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Enter estimated weekly revenue dollars $
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Handcare Program (soap / sanitizer)
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Enter estimated weekly revenue dollars $
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Air Freshener
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Enter estimated weekly revenue dollars $
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Linen Program
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Enter estimated weekly revenue dollars $
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Laundry / Housekeeping
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Enter estimated weekly revenue dollars $
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Waste Program
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Enter estimated weekly revenue dollars $
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Pest Control (Terminex)
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Enter estimated weekly revenue dollars $
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Other items sold
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Enter estimated weekly revenue dollars $
Opportunities - CBI products
Select CBI products that can be sold into this account.
Floor Cleaners & Misc. Items
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502031 - Concrete Cleaner - (heavy duty powder for removing oils and dirt from concrete) - 25#
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502065 - Quarry Tile Floor Cleaner (QTFC) - (acid based daily use anti slip quarry tile floor cleaner) - 4/1 gal
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502074 - Steady Step - (powdered anti slip floor cleaner equivalent to intuitional tide) - 36#
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502090 - Nutra Bac - (neutral disinfectant cleaner. Can also be used as a daily mop or damp mop.) - 2/1 Gal
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502100 - Select Neutral APC - (neutral damp mop and all purpose neutral cleaner) - 4/1 gal
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506096 - Select Block and Tile Whitener - (mold and mildew remover for tile also cutting board whitener) - 6/32oz
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510020 - Cyclone Detergent & Floor Cleaner - (portion pack anti slip quarry tile floor cleaner) - 125/1.5oz
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545234 - Shoot Out carpet cleaner - (vanishing action spotter for removing spots on carpet) - 6/18oz
Laundry Products
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512039 - LLP - powder lemon detergent - (bulk laundry powder) - 25#
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512042 - Tuff Laundry Detergent Powder - (bulk laundry powder) - 40#
Hand Soap
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514125 - Luxury Hand Soap-Bulk - (Pure coconut oil hand soap fro rich smooth lather) - 2/1 gal
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514131 - Pink Hand Soap-Bulk - (all purpose pink hand soap with high lather) - 4/1 gal
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514148 - Coconut Hand Soap with triclosan - (Coconut oil with triclosan) - 2/1 gal
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514155 - Bacti Crème Hand Soap-Bulk - (pink lotion hand soap, NOT antibacterial) - 2/1 gal
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514420 - Foaming Hand Soap - (cartridge) - 4/1000 ml
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514423 - Foaming Antibac Hand Soap - (cartridge) - 4/1000 ml
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514620 - Foaming Hand Sanitizer - (cartridge) - 4/1000 ml
Odor Neutralizers
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516011 - Snappy Apple - (air freshener) - 6/10 oz
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516016 - Tropic Breeze - (air freshener) - 6/10 oz
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516021 - Citrus Lemon - (air freshener) - 6/10 oz
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516204 - Yellow RTU Odor Neutralizer - (Clean scent odor neutralizing counteractant and deodorizer ) - 6/32oz
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516206 - Odor Go - (fabreez type product eliminates odors leave fresh smell) - 12/32oz
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516248 - Yellow - Odor Neutralizer - (Clean scent odor neutralizing counteractant and deodorizer ) - 2.5 gal
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545409 - Refresh - (urine eradicator, add to mop bucket for fresh bathroom floors) - 12/32oz
Sanitizers
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520011 - Foaming Disinfectant Spray - (foaming disinfectant cleaner compares/scrubbing bubbles) - 6/18oz
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520021 - Health Care Disinfectant Spray - (Disinfectant spray compares to Lysol) - 6/15.5oz
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520040 - Select Lemon Disinfectant Cleaner - (effective lemon scent disinfectant, Quat based) - 4/1 gal
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520090 - Steramie Tablets - (Quat Sani-Tabs) - 6/8oz
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520109 - Bio-San - (low temp sanitizer) - 4/1 gal
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520110 - Bio-San - (low temp sanitizer) - 5 gal
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520136 - Sani-Rinse II - (multi use Quat sanitizer dilute to 250 ppm) - 4/1 gal
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520137 - Sani-Rinse II - (multi use Quat sanitizer dilute to 250 ppm) - 5 gal
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545425 - Clear RTU no rinse sanitizer - (ready to use multi use Quat sanitizer diluted to 250 ppm ) - 6/32oz
All Purpose Cleaners
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522011 - All Purpose - (Aerosol all purpose cleaner) - 6/19oz
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545215 - Cameo - (Crème Cleanser) - 12/1qt
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522055 - Touch Up - (ready to use all purpose cleaner) - 6/32oz
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522071 - Freezer Cleaner - (non freezing) - 2/1 gal
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522130 - Select Pine Cleaner - (pine scented all purpose cleaner) - 4/1 gal
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522131 - Pine Plus - (pine cleaner with pine oil) - 2/1 gal
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522134 - Brisa General Purpose Cleaner - (Lavender fragrance general purpose cleaner (fabuloso)) - 4/1 gal
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522165 - Hi Ox general purpose cleaner - (oxygen all purpose cleaner) - 4/1 gal
Glass and Hard Surface
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524011 - Glass Cleaner Blue aerosol - (all purpose aerosol glass cleaner alcohol based ) - 6/19oz
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524014 - Blue RTU Glass Cleaner - (non ammoniated glass cleaner safe on plastics) - 6/32oz
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524020 - Select Glass & Hard Surface Cleaner - (Ammoniated hard surface cleaner and light duty degreaser) - 4/1 gal
Bowl Cleaners
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526005 - Winter Green Bowl Cleaner - (Premium acid bowl cleaner contains hydrochloric acid ) - 6/32oz
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526008 - VisiClean Bowl Cleaner - (Acid bowl cleaner contains hydrochloric acid ) - 12/32oz
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526010 - AFB Acid Free Bowl Cleaner - (non acid bowl cleaner RTU with flip up top) - 6/32oz
Kleen and Ultra Products
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527001 - Glass Kleen - (super concentrate must go thru dispensers closed loop top) - 4/1 gal
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527009 - Sani-Kleen - (ready to use table top cleaner and sanitizer) - 12/32oz
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527011 - Ordor-Kleen - (odor counteractant and neutralizer leaves fresh smell) - 4/1 gal
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527016 - Tub & Tile Kleen - (acid based fixture cleaner removes hard water stains) - 4/1 gal
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527019 - Bathroom Kleen - (non acid all purpose bathroom cleaner works well on oils) - 4/1 gal
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527021 - Purple Mean Kleen - (all purpose degreaser and cleaner) - 4/1 gal
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527023 - Lemon Disinfectant Kleen - (lemon scented disinfectant/cleaner) - 4/1 gal
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527025 - Wash N Go - (no rinse enzyme floor cleaner) - 4/1 gal
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527027 - EZ Floor Cl - (no rinse enzyme floor cleaner) - 4/1 gal
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527040 - Ultra Glass Cleaner - (super concentrated glass cleaner streak free) - 3-1/2 gal
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527043 - Ultra Degreaser - (super concentrated degreaser and gp cleaner) - 3-1/2 gal
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527045 - Ultra Disinfectant - (super concentrated disinfectant) - 3-1/2 gal
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527049 - Ultra Tub & Tile - (super concentrated acid base bathroom cleaner) - 3-1/2 gal
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527052 - Ultra Non-Acid Bathroom Cleaner - (super concentrated non acid bathroom cleaner) - 3-1/2 gal
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527055 - Ultra Citrus Neutral - (super concentrated neutral cleaner and damp mop) - 3-1/2 gal
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527061 - Ultra Air Freshener-Fresh Linen - (super concentrated air freshener and odor control) - 3-1/2 gal
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527063 - Ultra Air Freshener-Mango - (super concentrated air freshener and odor control) - 3-1/2 gal
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527066 - Ultra Quarry Tile Floor cleaner - (super concentrated quarry tile floor cleaner) - 3-1/2 gal
Degreasers
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528020 - Select HD Degreaser & Floor Cleaner - (heavy duty cleaner and degreaser for all kitchen needs) - 4/1 gal
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528050 - Hercules - (heavy duty degreaser and floor cleaner) - 4/1 gal
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528051 - Select All Purpose Degreaser - (premium grade all purpose cleaner and degreaser) - 4/1 gal
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528060 - Hercules - (heavy duty degreaser and floor cleaner) - 5 gal
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528115 - Citrus Plus - (heavy duty degreaser and floor cleaner) - 2/1 gal
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528127 - Dumpster Dandy - (connect to garden hose and spray controls odor & insects) - 2/64oz
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528128 - Dumpster Dandy - (connect to garden hose and spray controls odor & insects) - 4/32oz
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528154 - Neon - Spray Cleaner / Degreaser - (heavy duty degreaser and floor cleaner) - 4/1 gal
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528159 - Red - Degreaser - (heavy duty degreaser and floor cleaner) - 4/1 gal
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528163 - Neon - Spray Cleaner / Degreaser - (heavy duty degreaser and floor cleaner) - 2.5 gal
Oven Cleaners
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530010 - Fryolator Deep Fat Fry Cleaner - (bulk packed deep fryer cleaner and boil out) - 2/7#
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530011 - Fryolator Deep Fat Fry Cleaner - (portion packed deep fryer boil out cleaner) - 100/8oz
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530020 - Grease-Off Griddle & Hood Cleaner - (heavy duty thick vertical cling type product paint or wipe on) - 2/100oz
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530031 - Oven/Grill Foaming Cleaner - (aerosol oven cleaner, effective cleaner on all surfaces) - 6/18oz
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530057 - Select Grill /Oven Majic - (dissolves carbon and encrusted grease build up.) - 6/32oz
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530059 - Select Grill /Oven Majic - (dissolves carbon and encrusted grease build up.) - 2/1 gal
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530061 - Select Oven & Grill Cleaner - (premium liquid oven cleaner works on hot or cold surfaces) - 4/1 gal
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530100 - Oven Blaster - Alkaline Oven Cleaner - (premium liquid oven cleaner dissolves build ups quickly) - 3/32oz
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530103 - Oven Blaster - Alkaline Oven Cleaner - (premium liquid oven cleaner dissolves build ups quickly) - 4/1 gal
Drain Cleaners and Enzyme Treatments
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532015 - Main Drain - drain maintainer / cleaner - (fumeless fast acting drain opener) - 12/32oz
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532028 - Bac Man - (enzyme for grease traps & drains, urine & odor eradicator ) - 6/32oz
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532029 - Bac Man - (enzyme for grease traps & drains, urine & odor eradicator ) - 4/1 gal
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532030 - Bac Man - (enzyme for grease traps & drains, urine & odor eradicator ) - 5 gal
SS Polish
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534003 - Brassy - (non abrasive aerosol metal polish citrus scent) - 6/14oz
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534040 - WB SSP - Liquid - (water based stainless steel polish) - 6/32oz
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534031 - Stainless Steel Polish aerosol - (SS polish comparable to Sheila shine) - 6/16oz
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534121 - Lemon Shine furniture polish - (fruity lemon scented furniture polish) - 6/15oz
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534125 - Glow Cleaner and Polish - (all purpose polish for wood, plastics, and stainless) - 6/18oz
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545224 - SSC metal polish - (oil based cleaner and polish for metal surfaces) - 6/15oz
Pesticides
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538021 - Flying and Crawling Insect Spray - (insecticide housekeeping usage not used in food contact area) - 6/15oz
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538026 - Wasp & Hornet Spray - (insecticide housekeeping usage not used in food contact area) - 6/16oz
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538031 - Ant & Roach killer - (insecticide housekeeping usage not used in food contact area) - 6/18oz
Pot and Pan Detergent
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540009 - Sparkle Dish Machine Det - (portion packed for home style dish machines) - 200/1.5oz
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540010 - Super B - (solid pink pot and pan detergent) - 4/5#
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540020 - Snowey A/P Detergent Beads - (all purpose beaded all purpose powder cleaner) - 50#
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540040 - Economy P&P Detergent - (pink pot and pan detergent) - 4/1 gal
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540042 - Economy P&P Detergent - (pink pot and pan detergent) - 5 gal
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540050 - Lust H/D Pink - (pink lotion pot and Pan detergent high solids) - 4/1 gal
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540060 - Lust H/D Pink - (pink lotion pot and Pan detergent high solids) - 5 gal
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540100 - Sunshine - (premium high solid dish detergent match to Joy) - 4/1 gal
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540101 - Aurora Blue - (premium high solid dish detergent match to Dawn) - 6/28oz
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540102 - Aurora Blue - (premium high solid dish detergent match to Dawn) - 4/1 gal
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540105 - Sunshine - (premium high solid dish detergent match to Joy) - 5 gal
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540107 - Aurora Blue - (premium high solid dish detergent match to Dawn) - 5 gal
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540118 - OCP Solid Pot & Pan - (our clean planet pot and pan detergent) - 2/10#
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540120 - Power Pot & Pan Detergent - (heavy duty grease cutting pot and pan detergent) - 4/1 gal
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540140 - Power Pot & Pan Detergent - (heavy duty grease cutting pot and pan detergent) - 5 gal
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540166 - Select HD Lemon Pot & Pan - (lemon scented pot and pan detergent ) - 4/1 gal
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540170 - Platinum - (premium high solid dish detergent match to Dawn) - 5 gal
Presoaks & Delimers
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542005 - Plasticlean - (Dip it type stain remover safe for all surfaces) - 35/4oz
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542006 - Plasticlean - (Dip it type stain remover safe for all surfaces) - 2/8lb
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542012 - Silver Soak - (Liquid silver and flatware pre soak) - 4/1 gal
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542030 - Silver Brite - (powder silver pre soak with extra detarnishers) - 4/8#
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542042 - Striker - (solid flatware pre soak with detarnishers & enzymes) - 2/8#
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542050 - DeLime - (lime scale remover) - 4/1 gal
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542056 - Select Delimer - (lime scale remover) - 2/1 gal
Warewashing
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544005 - Bartender - (low suds bar soap) - 4/1 gal
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544025 - Meta Safe - (safe for soft metals, free rinsing works well in soft water) - 4/10#
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544031 - Bio-Clean - (low temp detergent) - 5 gal
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544040 - Power Clean - (encapsulated high temp detergent with stain removers) - 6/6#
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544043 - Extra Strength Plus - (solid dish detergent) - 4/8#
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544070 - Multi-Temp Detergent - (low or high temp liquid detergent) - 4/1 gal
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544072 - Liquid Metal Safe - (glass machine detergent for soft water applications) - 4/1 gal
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544074 - Multi-Temp Detergent - (low or high temp liquid detergent) - 5 gal
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544090 - Speed Dry - (hard water premium rinse aid) - 4/1 gal
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544100 - Super Rinse - (soft water rinse use with meta safe for spotless results ) - 4/1 gal
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544110 - Speed Dry - (hard water premium rinse aid best used with power clean) - 5 gal
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544111 - Bio-Rinse - (premium low temp rinse aid) - 5 gal
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544114 - Low Temp Rinse - (premium low temp rinse aid) - 5 gal
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544112 - Spots Away - (soft water rinse use with meta safe for spotless results ) - 5 gal
Finish
Finish, Comments and Signature
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Any other items requiring attention or any additional comments?
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Signature