Green Leaf’s optional online Facility Assessment is a valuable step in the cost estimation process.  The assessment is designed to provide us with more detailed information about your facility and its potentially unique cleaning needs.  It consists of basic questions about your facility, such as type, number of rooms and number of occupants.  With the completed assessment in hand, our staff can more accurately develop a cost estimate and, if desired, a cleaning program for your company’s facility.

The cost estimate process consists of the following four steps:

1. Complete and submit the optional online facility assessment form.  Green Leaf will then contact you to schedule a site visit.
   OR
2. Contact us to schedule a site visit by one of our specialists.
3. Green Leaf will conduct a facility assessment.
4. Your facility will receive a cost estimate for desired cleaning services shortly after our site visit.

If you don’t presently have all of the answers to the assessment questions, don’t worry!  Green Leaf’s facility specialist will help you find the answers and, if necessary, complete the form for you.

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1. General

Organization Name		Telephone		Main Office
Facility Address		Telephone		Cellular
Administration Contact
Name
Phone Number
Email address
Building Contact
Name
Phone Number
Email address

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2. Business/Organization Description

Type (e.g., small business, retail shop, manufactoring/repair shop, non-profit, school)
Number of ongoing occupants or employees
Total number of units/departments
Names of departments/units (optional)

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3. Green Cleaning Program

Is there a green cleaning program in place for the building/facility?	Yes No Date Instituted
If interested in or currently utilizing a green cleaning program, please provide Name(s) of main stakeholder(s)
Stakeholder #1
Name
Phone
Email
Stakeholder #2
Name
Phone
Email
Potential stakeholder(s) (optional)
Name
Phone
Email
Potential stakeholder(s) (optional)
Name
Phone
Email
Would you like to learn more information about green cleaning programs Yes No
Email

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4. Facility Cleaning Services

Does facility have janitor(s) on-site or existing service contractor? Yes No
B.  Custodial Resources
# Custodial Supervisors:
# of Custodians Working During Normal Hours:
# of Custodians Working After Normal Hours:
# of Non-Supervisory Full-Time Custodial Staff:
# of  Non-Supervisory Part-Time Custodial Staff:
Full-Time Equivalent Number of  Non-Supervisory Custodial Staff:
Note: Full-Time Equivalent Number of Non-Supervisory Custodial Staff represents the total number of custodians based on a 40-hour work week.  For example, part-time custodians working 32 hours a week represents 0.8 custodians  (32 hours/40 hours = 0.8 Custodians).
If yes, are you satisfied with arrangement, any preferable practices?
If yes, are there areas you would like to see improved?
Do you recycle ? Glass Paper Plastic Metals Other
Is the facility LEED (Leadership in Energy and Environmental Design) certified?
If no, is facility in the process of obtaining LEED certification?
Does facility have a custodian’s closet with sink?
Does facility have outside grounds keeper?

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5. Facility Description

Total square footage of occupied facility space
Square footage of high traffic areas
Square footage of medium traffic areas
Square footage of low traffic areas
Are there multiple buildings/structures on the grounds? Yes No
If yes, how many?
Green Leaf will fill out separate assessment for each additional building/structure.

Room Type	# of Rooms	Total Square Footage
Entrances (with grit or barrier mats?)	none 1 2 3 4 5 6 7 8 9 10
Lobby	none 1 2 3 4 5 6 7 8 9 10
General administrative offices	none 1 2 3 4 5 6 7 8 9 10
Staff offices	none 1 2 3 4 5 6 7 8 9 10
Workshop areas	none 1 2 3 4 5 6 7 8 9 10
Manufacturing areas	none 1 2 3 4 5 6 7 8 9 10
Repair shop areas	none 1 2 3 4 5 6 7 8 9 10
Clean up or special wash rooms	none 1 2 3 4 5 6 7 8 9 10
Conference rooms	none 1 2 3 4 5 6 7 8 9 10
Breakout rooms	none 1 2 3 4 5 6 7 8 9 10
Kitchen or pantry	none 1 2 3 4 5 6 7 8 9 10
Auditorium	none 1 2 3 4 5 6 7 8 9 10
Hallways	none 1 2 3 4 5 6 7 8 9 10
Stairwells	none 1 2 3 4 5 6 7 8 9 10
Gym	none 1 2 3 4 5 6 7 8 9 10
Locker rooms	none 1 2 3 4 5 6 7 8 9 10
Restrooms	none 1 2 3 4 5 6 7 8 9 10
Waiting rooms	none 1 2 3 4 5 6 7 8 9 10
Elevators	none 1 2 3 4 5 6 7 8 9 10
Nurse Office / medical treatment room	none 1 2 3 4 5 6 7 8 9 10
Cafeteria	none 1 2 3 4 5 6 7 8 9 10
Library	none 1 2 3 4 5 6 7 8 9 10
Indoor Parking garage	none 1 2 3 4 5 6 7 8 9 10
Boiler room	none 1 2 3 4 5 6 7 8 9 10
Storage rooms	none 1 2 3 4 5 6 7 8 9 10
Other (describe briefly, including square footage involved)
Exterior areas (describe briefly, including square footage involved)

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6. Flooring

Types of Flooring
Resilient flooring Linoleum Cork Other
Hard flooring Hardwood Pre-stained or veneer wood
Slate or tile Concrete Other
Any special concerns about flooring
Condition of flooring	Immaculate Clean Average Needs maintenance Poor
Comments
How frequently do floors receive restorative treatments?	Every 1 2 3 4 5 6 7 8 9 10 11 12 Month(s)
How frequently do floors receive interim treatment?	Every 1 2 3 4 5 6 7 8 9 10 11 12 Month(s)
Square footage of carpeted areas
Condition of carpet	Immaculate Clean Average Needs maintenance Poor
Comments
How frequently do carpets receive restorative treatments?	Every 1 2 3 4 5 6 7 8 9 10 11 12 Month(s)
How frequently do carpets receive interim treatments	Every 1 2 3 4 5 6 7 8 9 10 11 12 Month(s)
Are there areas in the building that are burnished, stripped, shampooed/extracted more often than other areas? Yes No
Comments
Does your facility currently have a carpet/floor maintenance plan for daily, interim, and restorative services? Yes No
Are traditional mops used to clean floors?
Are micro-fiber mops used to clean floors?
How often are high-traffic areas mopped or vacuumed?
How often are medium traffic areas mopped or vacuumed
How often are low-traffic areas mopped or vacuumed?
What other types of surfaces exist in the building?	Metal/stainless steel Tile chemistry lab benches Laminate Finished wood Other
Do any of these surfaces require special procedures or cleaning products? (List and describe below)
Surface	Special Procedure/Cleaning Product

 

 

7. Chemical Inventory

Supply Needs to be provided by cleaning contractor
Do you maintain an updated inventory of chemical products?
Does the chemical inventory information include:	None Purchase/expiration dates Amounts purchased Current amounts of chemical product in inventory Cost Material Safety Data Sheets (MSDS) Storage locations of the chemical products
Does the facility use a product-labeling system to assist non-English speaking personnel?
Does facility currently use green cleaning products approved by NYS OGS, or certified by Green Seal?
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Does the facility have a policy of purchasing concentrated cleaning chemicals  that require diluting instead of purchasing ready-to-use products (with water already added)?
Does the custodial staff use automated dilution station(s) to dilute concentrated cleaning chemicals?

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8. Building Population

Number of people that occupy facility?
Does the facility track occupant health issues?
Absenteeism due to occupant illness (in staffyears for 2011 or 2012)
Any occupants or visitors/patients with special needs relevant to facility cleaning? Please describe needs
Has facility been cited for health issues in last 2 years? Please explain briefly
Describe current cleaning remediations that address these needs
Are any of the special needs populations sensitive to indoor air quality?
Do the special needs populations attend or work in specific locations within the facility (I.e., special education classrooms)?
Are the special needs populations interspersed throughout the facility?
Do the rooms occupied by these special needs populations have special custodial requirements? (List requirements below.)	None Glass Cleaner Cleaner Bathroom Cleaner
Comments/ Message:
Security Code: