W911SA22Q3023 UT034 CU Attach. 4 - Service Ticket Template V 1.6.pdf

On Site

Service Ticket – Custodial

Version 1.6; 18 JAN 2019

Contract number: _____________________ Location: _____________________

DATE: __________

Custodial Service TYPE (include all): ☐Dust Mop ☐Damp Mop ☐Spray Buff, Burnish

☐Strip, wax, Buff ☐Seal, Polish ☐Remove Trash ☐Vacuum ☐Carpet Shampoo

☐Service Restrooms (Clean/Sanitize toilets, urinals, sinks, showers, walls, partitions)

☐ Contractor Restroom Cleaning Sheet completed

☐Restroom floor cleaning ☐Low Dusting ☐High Dusting ☐Window Cleaning

Comments:

Check In/Out:

Vendor Employee(s) Name (print):_________________________________________________

Designated Rep. Person Check-In Print Name: ________________________________________

Designated Rep. Person Check-Out Print Name: ______________________________________

This Service Ticket shall be filled out by the contracted vendor each time the service provider performs services on location. This service ticket does not provide proof of inspection or acceptance of services. The Government reserves the right to fully inspect work performance of all requirements under contract any time or place it deems necessary.