Information

  • Account Name

  • Account #

  • SiteID

  • Contact

  • Location
  • Phone Number

  • email Address

  • Conducted On

  • Prepared By

Dishmachine Process Area

  • Insert a Picture of the Dishmachine and the Area around it

Dishmachine General Info

  • Make

  • Model

  • Voltage

  • Serial Number

Dishmachine Dispensers

  • Dishmachine Dispenser

  • Serial Number

Encapsulated / Solid Bowls

  • Encapsulated / Solid Bowl

  • Serial Number

  • Dishmachine Water Hardness

  • Dishmachine Water TDS

  • Dishmachine Detergent

  • Dishmachine Rinse Additive

  • Dishmachine Sanitizer

Dishmachine Current Results

  • Water / Ice Tea Glasses

  • Describe

  • Stemware

  • Describe

  • Plates and Saucers

  • Describe

  • Cups and Bowls

  • Describe

  • Flatware

  • Describe

Dishmachine Inspection

Machine Controls

  • Pre Wash Temperature

  • Was Repair Completed

  • Wash Tank Temperature

  • Was Repair Completed

  • Power Rinse Temperature

  • Was Repair Completed

  • Final Rinse Temperature

  • Was Repair Completed

  • Final Rinse Pressure

  • Was Repair Completed

  • Fresh Water Feedback

  • Was Repair Completed

  • Energy Saver

  • Was Repair Completed

Mechanical Operation

  • Fill Valve

  • Was Repair Completed

  • Wash Arms / Rinse Arms

  • Was Repair Completed

  • Final Rinse Jets

  • Was Repair Completed

  • Final Rinse Solenoid

  • Was Repair Completed

  • Overflows

  • Was Repair Completed

  • Drain Valves

  • Was Repair Completed

  • Rinse Saver

  • Was Repair Completed

  • Conveyor Belt / Chain

  • Was Repair Completed

  • Curtains / Racks

  • Was Repair Completed

Operator Procedures

  • Racking

  • Was Repair Completed

  • Presssrapping

  • Was Repair Completed

  • Presoaking

  • Was Repair Completed

  • Deliming

  • Was Repair Completed

  • Curtain Cleaning

  • Was Repair Completed

  • Tank Water Change / Fill

  • Was Repair Completed

  • Scrap Tray Cleaning

  • Was Repair Completed

  • Equipment Cleaning

  • Was Repair Completed

Presoak Process Area

  • Insert a Picture of the Presoak Area

Presoak General Info

  • Presoak Dispenser Model

  • Presoak Product

  • oz./gal dispensed

Dishmachine Inspection

  • Chemical Pick up tubing

  • Was Repair Completed

  • Check Valves

  • Was Repair Completed

  • Chemical calibration

  • Was Repair Completed

  • Dispenser Product Stickers

  • Was Repair Completed

Pot & Pan Three Sink Process Area

  • Insert a Pictiore of the Three Compartment Sink Area

Pot & Pan Three Sink General Info

  • Pot & Pan Dispenser Model

  • Pot & Pan Product

  • oz./gal dispensed

  • Third Sink Sanitizer Dispenser

  • Sanitizer Product

  • ppm level

Pot and Pan Current Results

  • Pots and Pans

  • Describe

  • Dishes

  • Describe

  • Food Preparation Surfaces

  • Describe

Pot & Pan Inspection

  • Dispenser repairs

  • Was Repair Completed

  • Pick up tubing

  • Was Repair Completed

  • Feed tubing to sinks

  • Was Repair Completed

  • Check Valves

  • Was Repair Completed

  • Chemical calibration

  • Was Repair Completed

  • Water valve connections

  • Was Repair Completed

  • Saddle valve

  • Was Repair Completed

  • Chlorine Test Strips

  • Was Repair Completed

  • Quaternary Test Strips

  • Was Repair Completed

  • Wall Chart

  • Was Repair Completed

  • Wash/Rinse/Sanitizer Stickers

  • Was Repair Completed

  • Fill to this Line Stickers

  • Was Repair Completed

  • Dispenser Product Stickers

  • Was Repair Completed

Kitchen Ancillary Process Area

  • Insert a Picture of the Ancillary Kitchen Area

Kitchen Ancillary General Info

  • Ancillary Dispenser Model

Glass Cleaner Product

  • Swisher Blue RTU Glass Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Glass Cleaner, Aerosol

  • Tip Color

  • oz./gal dispensed

  • Swisher Glass Kleen

  • Tip Color

  • oz./gal dispensed

  • Swisher Select Glass & Hard Surface Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Ultra Glass Cleaner

  • Tip Color

  • oz./gal dispensed

APC Product

  • Swisher Aerosol All Purpose Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Brisa General Purpose Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Citrus Plus

  • Tip Color

  • oz./gal dispensed

  • Swisher OCP Hi-Ox

  • Tip Color

  • oz./gal dispensed

  • Swisher Pine Plus

  • Tip Color

  • oz./gal dispensed

  • Swisher Select Neutral APC

  • Tip Color

  • oz./gal dispensed

  • Swisher Select Pine Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Ultra Citrus Neutral

  • Tip Color

  • oz./gal dispensed

Floor Cleaner Product

  • Swisher Concrete Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Cyclone Detergent & Floor Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Dust Mop Treatment

  • Tip Color

  • oz./gal dispensed

  • Swisher EZ Floor Cl

  • Tip Color

  • oz./gal dispensed

  • Swisher Gold Medalist Floor Finish

  • Tip Color

  • oz./gal dispensed

  • Swisher Quarry Tile Floor Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Steady Step

  • Tip Color

  • oz./gal dispensed

  • Swisher Ultra Quarry Tile Floor Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Wash N Go

  • Tip Color

  • oz./gal dispensed

Degreaser Product

  • Tip Color

  • oz./gal dispensed

  • Swisher Hercules

  • Tip Color

  • oz./gal dispensed

  • Swisher Neon - Spray Cleaner / Degreaser

  • Tip Color

  • oz./gal dispensed

  • Swisher Purple Mean Clean

  • Tip Color

  • oz./gal dispensed

  • Swisher Red - Degreaser

  • Tip Color

  • oz./gal dispensed

  • Swisher Select All Purpose Degreaser

  • Tip Color

  • oz./gal dispensed

  • Swisher Select HD Degreaser & Floor Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Synplex Steam Clean Compound

  • Tip Color

  • oz./gal dispensed

  • Swisher Touch Up

  • Tip Color

  • oz./gal dispensed

  • Swisher Ultra Degreaser

  • Tip Color

  • oz./gal dispensed

Other Products Installed

  • Swisher DeLime

  • Tip Color

  • oz./gal dispensed

  • Swisher Select Delimer

  • Tip Color

  • oz./gal dispensed

  • Swisher Fryolator Deep Fat Fry Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Fryolator Deep Fat Fry Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Grease-Off Griddle & Hood Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Oven & Grill Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Oven Blaster - Alkaline Oven Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Oven Blaster - Alkaline Oven Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Oven/Grill Foaming Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Select Grill /Oven Majic

  • Tip Color

  • oz./gal dispensed

  • Swisher Select Grill /Oven Majic

  • Tip Color

  • oz./gal dispensed

  • Swisher Select Oven & Grill Cleaner (RTU)

  • Tip Color

  • oz./gal dispensed

  • Swisher Clear RTU No Rinse Sanitizer

  • Tip Color

  • oz./gal dispensed

  • Swisher Sani-Kleen

  • Tip Color

  • oz./gal dispensed

  • Swisher Dumpster Dandy

  • Tip Color

  • oz./gal dispensed

  • Swisher Dumpster Dandy

  • Tip Color

  • oz./gal dispensed

  • Swisher Lime - Veggie Wash

  • Tip Color

  • oz./gal dispensed

  • Swisher Select Block and Tile Whitener

  • Tip Color

  • oz./gal dispensed

  • Swisher Stainless Steel Polish, Oil based

  • Tip Color

  • oz./gal dispensed

  • Swisher Stainless Steel Polish, Water Based

  • Tip Color

  • oz./gal dispensed

  • Swisher Wasp & Hornet Killer

  • Tip Color

  • oz./gal dispensed

  • Swisher WB SSP - water based stainless polish

  • Tip Color

  • oz./gal dispensed

  • Swisher Bac Man

  • Tip Color

  • oz./gal dispensed

  • Swisher Bac Man

  • Tip Color

  • oz./gal dispensed

  • Swisher Bac Man

  • Tip Color

  • oz./gal dispensed

  • Swisher Main Drain - drain maintainer / cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Antibacterial Foam Soap

  • Tip Color

  • oz./gal dispensed

  • Swisher Bacti Crème Hand Soap-Bulk

  • Tip Color

  • oz./gal dispensed

  • Swisher Coconut Hand Soap

  • Tip Color

  • oz./gal dispensed

  • Swisher Foam Alcohol Hand Sanitizer

  • Tip Color

  • oz./gal dispensed

  • Swisher Foam Luxury Soap

  • Tip Color

  • oz./gal dispensed

  • Swisher Luxury Hand Soap-Bulk

  • Tip Color

  • oz./gal dispensed

  • Swisher Pink Hand Soap-Bulk

  • Tip Color

  • oz./gal dispensed

  • Swisher Brassy Metal Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Cameo Crème Cleanser

  • Tip Color

  • oz./gal dispensed

  • Swisher Flying Insect Killer

  • Tip Color

  • oz./gal dispensed

  • Swisher Freeze Gum Remover

  • Tip Color

  • oz./gal dispensed

  • Swisher Freezer Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Glow Cleaner Polish

  • Tip Color

  • oz./gal dispensed

  • Swisher Lemon Plus Furniture Polish

  • Tip Color

  • oz./gal dispensed

  • Swisher Lemon Shine Furniture Polish

  • Tip Color

  • oz./gal dispensed

  • Swisher Marble & Granite Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Ultimate Floor Finish 622

  • Tip Color

  • oz./gal dispensed

  • Swisher Knockout Floor Stripper

  • Tip Color

  • oz./gal dispensed

  • Swisher Floor Sealer

  • Tip Color

  • oz./gal dispensed

  • Swisher Air Freshener - Citrus Lemon

  • Tip Color

  • oz./gal dispensed

  • Swisher Air Freshener - Snappy Apple

  • Tip Color

  • oz./gal dispensed

  • Swisher Air Freshener - Tropic Breeze

  • Tip Color

  • oz./gal dispensed

  • Swisher Odor Go

  • Tip Color

  • oz./gal dispensed

  • Swisher Ordor-Kleen

  • Tip Color

  • oz./gal dispensed

  • Swisher Refresh

  • Tip Color

  • oz./gal dispensed

  • Swisher Ultra Air Freshener-Fresh Linen

  • Tip Color

  • oz./gal dispensed

  • Swisher Ultra Air Freshener-Mango

  • Tip Color

  • oz./gal dispensed

  • Swisher Yellow - Odor Neutralizer

  • Tip Color

  • oz./gal dispensed

  • Swisher Yellow RTU Odor Neutralizer

  • Tip Color

  • oz./gal dispensed

  • Swisher Ant & Roach Ant Killer

  • Tip Color

  • oz./gal dispensed

  • Swisher Bathroom Kleen

  • Tip Color

  • oz./gal dispensed

  • Swisher Tub & Tile Kleen

  • Tip Color

  • oz./gal dispensed

  • Swisher Ultra Tub & Tile

  • Tip Color

  • oz./gal dispensed

  • Swisher AFB Acid Free Bowl Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Visclean

  • Tip Color

  • oz./gal dispensed

  • Swisher Winter Green Bowl Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Foaming Germicidal Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Health Care Disinfectant

  • Tip Color

  • oz./gal dispensed

  • Swisher Lemon Kleen Disinfectant

  • Tip Color

  • oz./gal dispensed

  • Swisher Nutra Bac

  • Tip Color

  • oz./gal dispensed

  • Swisher Select Lemon Disinfectant Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Ultra Disinfectant

  • Tip Color

  • oz./gal dispensed

  • Swisher Ultra Non-Acid Bathroom Cleaner

  • Tip Color

  • oz./gal dispensed

  • Swisher Shootout Carpet Spotter

  • Tip Color

  • oz./gal dispensed

Miscellaneous

  • Chemical Pick up tubing

  • Was Repair Completed

  • Check Valves

  • Was Repair Completed

  • Chemical calibration

  • Was Repair Completed

  • Quaternary Test Strips

  • Was Repair Completed

  • Wall Charts

  • Was Repair Completed

  • Wall Brackets

  • Was Repair Completed

  • Dispenser Product Stickers

  • Was Repair Completed

  • MSDS on location for all products

  • Was Repair Completed

  • MSDS Book/Station

  • Was Repair Completed

Account Penetration

  • In this section, identify any potential upselling opportunities.

  • Warewashing Program

  • Enter estimated weekly revenue dollars $

  • Laundry / Housekeeping

  • Enter estimated weekly revenue dollars $

  • Linen Program

  • Enter estimated weekly revenue dollars $

  • Waste Program

  • Enter estimated weekly revenue dollars $

  • Swisher Total Image

  • Enter estimated weekly revenue dollars $

  • Paper (towel, tissue, seat covers, etc.)

  • Enter estimated weekly revenue dollars $

  • Handcare Program (soap / sanitizer)

  • Enter estimated weekly revenue dollars $

  • Air Freshener

  • Enter estimated weekly revenue dollars $

  • Other items sold

  • Description of what was sold

  • Enter estimated weekly revenue dollars $

section

  • Any other items requiring attention or any additional comments

  • signature

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