General Info (ပံုမွန္အခ်က္အလက္မ်ား)

Add location
Select date

Type of home (အိမ္အမ်ိဳးအစား)

Picture (ဓါတ္ပံု)
Number of People (အိမ္ရွိလူဦးေရ)
Period of living in this home (ေနထိုင္ၿပီးေသာကာလ)

Q&A (ေမးေျဖအပိုင္း)

Available

Type of Septic tank (အိမ္သာအမ်ိဳးအစား)

Type of problem (ျဖစ္တတ္ေသာ ျပႆနာမ်ား)

Frenquency of Problems (ျဖစ္ေသာအႀကိမ္အေရအတြက္)

Solutions of Problem (မည္သို႔ေျဖရွင္းခဲ့သနည္း)

Effectiveness of Problem Solving (ရာခိုင္ႏွဳန္းေျဖရွင္းမႈ)

Brand of Cleaning Product. (အသံုးျပဳေသာသန္႔ရွင္းေရးပစၥည္း)

Product shoping at? (သန္႔ရွင္းေရးပစၥည္းဝယ္ယူေသာေနရာ)

If other (တစ္ျခားဆိုလွ်င္)

Is there any other cleaning products or solution wish to shop? (တစ္ျခားေသာ လိုအပ္မည္ဟုထင္ေသာ သန္႔ရွင္းေရးပစၥည္း သို႔ ေျဖရွင္းရန္ျပႆနာ)

Will you interest in testing an eco-green product that will solve the septic problem? (သင္သည္ ပတ္ဝန္းက်င္ကို အေထာက္အကူျပဳေသာ အိမ္သာက်င္းျပႆနာကိုေျဖရွင္းေသာ ပစၥည္းကို စမ္းသပ္သံုးစြဲျခင္ပါသလား)

If "Yes" when is the convience day for testing? (စိတ္ဝင္စားပါက စမ္းသပ္ရန္ သင့္ေတာ္ေသာ ေန႔)

Applicient's Signature (အိမ္ပိုင္ရွင္ သို႔ ေျဖဆိုသူ၏ လက္မွတ္)
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.