B08. Attachment 0005- PEST CONTROL TREATMENT NOTIFICATION FORM.pdf
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- Attached to
- Pest Control Services
- Solicitation number
- W519TC26QA023
About this file
This is a template for a Pest Control Treatment Notification Form that contractors must use to notify occupants of scheduled pest control services at federal facilities. The form requires the contractor to insert their name, the notification date, specific building or quarters numbers, the type of service treatment, and the scheduled date and time of service. Occupants will generally be required to vacate the treated spaces during the actual service performance.
The form outlines mandatory precautionary measures occupants must complete prior to treatment, which vary by facility type: barracks personnel must remove locker contents and unlock all areas; mess halls, clubs, and commissaries must store or cover open food and clean utensils; hospital ward personnel in charge must be present to define work scope and communicate restrictions; family housing occupants must unlock cabinets and closets, refrigerate open food, cover other food items, and notify the housing office if infants or elderly individuals occupy the quarters; and office building occupants must unlock all desks and cabinets. The contractor provides contact information and invites occupant feedback on service quality and work performance. The form concludes with a signature line for contractor authorization.
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Text version
Attachment C: PEST CONTROL TREATMENT NOTIFICATION FORM
From: Insert Contractor Name Date: Insert date To: Occupants
The following quarters, buildings, and/or areas have been scheduled for pest control treatment as shown below:
Building or Quarters Number Insert Bldg/Qtr No is scheduled for Insert type service treatment on Insert Date from Insert Time of Day to Insert Time of Day
SPECIAL NOTES
In most cases, occupants will be required to vacate the space(s) concerned for a brief period while the services are actually being performed. Prior to treatment, occupants are required to accomplish the following precautionary measures:
1. Barracks. If feasible, remove contents of personal lockers and place on bunk. Open all locked areas.
2. Messes, Clubs, Commissaries. Store all open food if possible; otherwise, cover with protective cloth, paper, or plastic. Remove utensils or wash before using.
3. Hospital Wards. The person in charge of each ward must be present immediately prior to treatment to define the scope of work allowed at that particular time, or communicate any restrictions that might be in effect.
4. Family Housing. Open all cabinet and closet doors. Place open food in the refrigerator. Cover food, such as vegetables, fruit, etc., with protective cloth, paper, or plastic.
Remove utensils or wash before using. Advise the housing office or the contractor if the quarters are occupied by infants or elderly individuals.
5. Office Buildings. Have all desks and cabinets unlocked and available for treatment.
NOTE: It is the desire of Insert Contractor’s Name to give efficient, effective, and economical pest control services. Any suggestions are welcomed, as well as comments regarding the manner in which the work is performed.
Telephone: Insert Phone No. THANK YOU, (Contractor’s signature)
| From: Insert Contractor Name Date: Insert date |
| SPECIAL NOTES |
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