Title Page
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Date/Time
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Inspector Name
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Manager Name
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Site
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Floor/Area
Coordination with Client
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1) Met with client (date & provided instruction)*
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2) When will the building reopen?
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3) What will the building operating hours and days be?
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4) What will the occupancy be at reopening?
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4a) Is this a Phased re-opening? (If yes, add a note to explain phase planning & timeline)
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5) What hours/shifts of coverage will be needed for CWS ee's?
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6) Does the client have any special requirements to reactivate furloughed employees? (ex. reset badge access, rerun background checks & drug screens) (If yes, add a note to explain)
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7) Are additional services needed? (If yes, add a note to explain)
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8) Has the scope of work (SOW) been reviewed with the client prior to returning to the facility?
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9) Have we reviewed the Level 1, Level 2 and Level 3 Cleaning and Disinfecting Requirements?
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10) Do we have client authorization to execute additional work? (If yes, attach authorization confirmation)
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11) Have we been requested to do Level 3 cleaning?
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11a) If so, have we notified HSSE for review and included HSSE team in the reviewal of expectations?
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12) Do we have both VP and HSSE authorization to level 3 cleaning? (If yes, attach required information sent to HSSE for review and approval)
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13) Is additional staffing needed for additional services? (If yes, add a note to explain)
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14) Validation of Cleaning and Disinfecting, explain how we are reporting either though management verification forms or audit findings
