Field Observation Sheet - GSS v3

• Name of Customer

• Address
  Address

• Contact No

• Service / Contract Type

• Type of Premise

• Total no. of Floors

• Treated area situated on : Ground Floor / 1st Floor /

• Covered area (in Sq.ft.)

• Conducted on

  Date

• Prepared by

• Pest Infestation observed

• Add media

  Media

• Specimen collected and identified as

• 1 . Key Characteristic features that helped in identification

  Select German Cockroach American Cockroach Brown Banded Cockroach

  • German Cockroach
  • American Cockroach
  • Brown Banded Cockroach

• 2. Pest's sign of infestation noitced

  Select German Cockroach American Cockroach Brown Banded Cockroach

  • German Cockroach
  • American Cockroach
  • Brown Banded Cockroach

• 3. Specific area where infestation noticed

  Select German Cockroach American Cockroach Brown Banded Cockroach

  • German Cockroach
  • American Cockroach
  • Brown Banded Cockroach

• 4. Pests 'hot spots' and hide outs noticed

  Select German Cockroach American Cockroach Brown Banded Cockroach

  • German Cockroach
  • American Cockroach
  • Brown Banded Cockroach

• 5. Type of pest related damages noticed

  Select German Cockroach American Cockroach Brown Banded Cockroach

  • German Cockroach
  • American Cockroach
  • Brown Banded Cockroach

• 6. Prevailing hygiene & Sanitation conditions

• Add media

  Media

• 7. Do's and Don'ts suggested by Technician

• 8. Customer queries (if any)

• 9. Other observations, queries & Service USPs

• Add media

  Media

Details of Pesticides / Traps used by Technicians

• Total quantity of pesticide used (in ml.)

• Total quantity of pesticide used (in ml.)

• Total no. of gel dots placed

• Total no. of IMT / Exoroach placed (............./................)

• List all other equipment / PPEs used during service

• Name & Signature of Mentor

  Sign