Laundry Site Survey Form
Your Name
*
First Name
Last Name
Your Email
*
example@example.com
Distributor Name or Direct?
*
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Client Details
Client Venue Name
*
New Client or Existing Client
*
New Client
Existing Client
Client Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Client Primary Contact Name
*
Name
Position
Client Contact Email
*
This is where service reports will be emailed to, you can enter more than one.
Client Contact Number
*
Primary Contact is Available
Rows
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
AM
PM
Service Call Time
Delivery Options
*
Please Select
Hand Unload
Tailgate Unload
Forklift Unload (Forklift onsite)
Installation Request date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
This is a request date only. All Installation are scheduled by the Installation Service Manager.
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Location - 1 Service Details
Location Name
*
Call Frequency
*
Please Select
2 Weeks (PLATINUM)
4 Weeks (GOLD)
8 Weeks (SILVER)
16 Weeks (BRONZE)
Laundry Type
OPL
Laundromat
Customer Sector Served
Age Care
Hospitality
B&B
Mining
Industrial
Laundromat
Other
Existing Wash Programs
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Photo required of exisiting wash programs if applicable.
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Existing or New Machines?
*
Existing
New
Number of Washers
Washer Model / Size
Photos Required: Serial Plate, Washer, Washer Console/Digital Display
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General Notes
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Laundry Operations
Site Turnover / Week (Tonnage or Cycles per Day per Machine)
Days per Week Laundry Runs
Hours of Operation
Staff per Day / Shift Times
Request a floor plan of the laundry area if available. If not available, take a photo of the Fire Evacuation Plan.
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Dispenser Details
Exiting Dispenser Present?
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Is Power Close to the dispenser?
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Distance to power?
Are there water outlets close to the dispenser?
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Distance from Water Outlet
Do machines run from manifold or direct injection?
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Manifold / Direct injection
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Existing infrastructure
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Tray / Cable / Tube
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Distance – Dispenser to Farthest Wash Machine (metres)
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Products
Product Pack Size
10L
20L
200L
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Product Range
OPL Bleach
OPL Builder
OPL Detergent
OPL Detergent Sanitiser
OPL Emulsifier
OPL Oxy LT
OPL Softener
OPL Sour Plus
OPL Laundry Soak
OPL Laundry Powder
File Upload
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Mixing Station Required
*
Yes - Water Fed (Pro Max)
Yes - Waterless (Eco Shot)
No
Pro Max - Mixing Station Options
Rows
1
2
0
1 Product Bucket
4 Product Bottle
4 Product Bucket
3 Product Bottle & 1 Product Bucket
Products for Faceplate
Rows
Product 1
Product 2
Product 3
Product 4
Faceplate 1
Faceplate 2
Faceplate 3
Faceplate 4
Eco Shot - Mixing Station Options
Rows
1
2
3
4
5
0
Smartpump Bottle Fill
Smartpump Bucket Fill
Products for Faceplate
Rows
Product 1
Product 2
Product 3
Product 4
Product 5
Product Stickers
Sink Pump Options
Rows
1
2
0
Hydro Pump 616
Pelican Pump
Smartpump Sink Fill
Manual Dishwashing Chemical Required
Rows
Product Name
Product Size
Detergent
Racks Options
Rows
1
2
3
4
5
0
Rack 5L x 1 (Narrow)
Rack 5L x 1 (Wide)
Rack 5L x 2 (Narrow)
Rack 5L x 2 (Wide)
Wall Charts
Rows
1
2
3
4
5
0
Guidelines For Handling Chemicals
Proper Hand-Washing and Sanitising
SDS and Product Chart
Is HandCare Required?
Yes
No
Number of Dispensers?
Product Required
Rows
Yes
No
Hand & Body Wash
Hand & Body Foam
Antibac Wash (kitchen)
Antibac Foam (kitchen)
Antibac Hand & Body Wash
Antibac Hand & Body Foam
Sani Gel (Alcohol)
Sani Hands (Alcohol free)
Dispenser Install Surface
Please Select
Mirror / Glass
Plasterboard
Concret
Tiled
Fibro / Cement
Steel
Wood
What surface is the HandCare dispenser being installed on?
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Location comments
Comments
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