Survey - Data Clean

Contact Information

Name:

Company:

Email:

Phone:

Service Location Information

Address:

City:

State:

Zip:

Floor Level/Number:

Room Name or Description:

Details

Age of Room Since Built
or Last Renovation (yrs):

Total Sq. Ft. to be Cleaned:

Preferred Service Timeframe:
(check all that apply)

Any Day Weekdays Weekends Any Time 1st Shift 2nd Shift 3rd Shift

Last Professional Cleaning:

Within last quarter Within last year More than 12 month ago and/or I don't know

Fire Suppression:
(check all that apply)

Water Gas None

How DENSE is the Room Layout?

1 2 3 4 5

(1) Most of the room is wide open space.
(5) Most of the room is filled with equipment.

Does the room have Raised Access Flooring (RAF)?

Yes No

Are RAF panels screwed down?

Yes No

Depth of Underfloor Plenum:

6" 12" 18" 24"

Other:

Is this Underfloor an Active Airflow Plenum?

Yes No

Underfloor Contamination Level:

1 2 3 4 5

(1) No visible debris and no dust on hand when slab is wiped.
(3) Visible debris and dust on hand when slab is wiped.
(5) Very dirty - dust blows up when floor tiles are lifted - large amount of visible debris.

Types of Cables in the Underfloor:
(check all that apply)

None Power Data Cable Trays

Flooring Surface:
(check all that apply)

RAF with HPL surface RAF with carpeted surface

On slab epoxy or other sealed concrete On slab VCT On slab carpet
Steps Ramp(s)

Flooring Contamination Level:

1 2 3 4 5

(1) very clean - looks brand new.
(3) visible contaminant build-up, scuff marks, etc.
(5) very dirty - scuff marks, spots, dust bunnies, etc.

Finished Ceiling:

None, Open to Deck

Height Above Finished Floor (ft):

Suspended (ceiling tiles)

Height Above Finished Floor (ft):

Hard finished ceiling, e.g. drywall

Height Above Finished Floor (ft):

Overhead Cable Trays/Ladder Racks:

Yes No

Is the Room Divided by Cages?

Yes No

Do Cage Walls Extend Below RAF?

Yes No

Are Aisle Containment Systems Installed?

Yes No

FACILITY SURVEY

Contact Information

Service Location Information

Details