Supply and Equipment Checkout Form
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
REGULAR CADDY
Rows
Filled
Received
Towel in bottom of caddy x 2
AP
Bags - large
Bags - small
BK
Brush - drain
Brush - grout
Brush - metal
Brush - nylon
CT
DG
DS
ENZ
G - spray
H2 Orange
HP
ME
ND
Oil cloth
OW (Liquid Gold)
Plastic cup x 2
Pumice
Scrungee
SG
Squeegee
Toilet sponge
White Scrubby
TUFF STUFF CADDY
Rows
Filled
Received
A
B
Gel gloss
OC
Plant Shine
Vinegar
EQUIPMENT
Rows
Filled
Received
Blade
Broom
Brush - Deck
Bucket
Cobwebber head
Cobwebber pole
Dustpan
Eyewash station
Glove liners - 5 pair
Mop
Shoe covers
Stepstool
Swiffers - 5
Swiffer sticks
Vacuum
Vacuum attachments & bag
Vacuum - Replacement filters
Vacuum tags
TOWELS, MOP PADS, & Other
Rows
Filled
Received
Towels - 40
Microfibers - 35
Mop pads - 14
Net bags - 3
Laundry Soap
First Aid Kit
Money Pouch
The total value of the equipment and supplies you are receiving is $550. All items must be returned on or before the last day that you work for American Maid Service. Any items not returned without a conversation will be reported as "theft" and the value may be deducted from your final paycheck.
I understand the statement above and I agree to return all items belonging to American Maid Service upon my termination with the company. Please choose an option below for your response.
*
NO
YES
Printed Name of Person Receiving Supplies and Equipment
*
Signature of Person Receiving Supplies and Equipment
*
Printed Name of Office Staff
*
Signature of Office Staff
*
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