Jobsite – Boss Hood Cleaning

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Job Summary

Customer *

Owner / Manager / DM

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Service Date *

Time In *

Time Out *

Vehicle *

Service Photos *

All Required Photos Taken
Additional Photos (if deficiencies, list below)

Driver Name *

Description of Compliance Issues / Deficiency Photos

Must have written documenation and description on C/D Report. Any and all deficiencies and/or compliance issues must be photographed and/or documented.

Job Notes

Technicians on site *

Select ALL technicians on site.

Pilot light(s) ON: *

Yes
No (explain below)

Pilot light(s) NOT on:

Explanation if pilot light(s) are not on upon job completion.

Completion & Deficiency Report

for Commercial Kitchen Exhaust System Service

Licensed Tech Name: *

First

Last

Last Service / Cleaning Date *

Previous Cleaning Company *

Last Suppression System Service *

Previous Suppression System Company *

Service Completion Checklist

Any NO answer requires that the deficiency portion of this report to be completed and/or submitted to the proper authority having jurisdiction.

1. Filters Clean *

Line 1 – Notes *

2. Precipitators / pollution control devices clean *

Line 2 – Notes *

3a. Grease load < 2000 microns: Horizontal *

Line 3a – Notes *

3b. Grease load < 2000 microns: Vertical *

Line 3b – Notes *

3c. Grease load < 2000 microns: Hood *

Line 3c – Notes *

4. Grease load in the fan < 3175 microns *

Line 4 – Notes *

5a. Is the on-site exhaust system diagram available and accurate? *

Line 5a – Notes *

5b. Did you inspect or clean the entire system as specified in on-site exhaust system diagram? If no, specify under Comments and Deficiencies *

Line 5b – Notes *

6. Service label signed, dated, and placed in a conspicuous location on the hood *

Line 6 – Notes *

7a. Filters tightly fit together and in place *

Line 7a – Notes *

7b. If wash system, main water valve open *

Line 7b – Notes *

8. Fans operate *

Line 8 – Notes *

9. Exhaust fan louvers cleaned and checked *

Line 9 – Notes *

10. Exhaust fan(s) cleaned *

Line 10 – Notes *

11. Exhaust fan belts and pulleys inspected and in good working order *

Line 11 – Notes *

12. Grease cups cleaned *

Line 12 – Notes *

13. The system appears to be liquid tight *

Line 13 – Notes *

14. Horizontal duct(s) cleaned and/or inspected *

Line 14 – Notes *

15. Vertical duct(s) cleaned and/or inspected *

Line 15 – Notes *

16. Sufficient access panels provided *

Line 16 – Notes *

17. Access panel(s) have proper signage *

Line 17 – Notes *

18. All areas of exhaust system are accessible *

Line 18 – Notes *

19. Hood and exhaust system are free of obstructions *

Line 19 – Notes *

20. Cleaning complied with NFPA 96 *

Line 20 – Notes *

Service Frequency *

Type of cooking system(s), check all that apply:

Solid Fuel
Charbroil
Wok
Other

Other Cooking System: (specify)

Comments / Deficiencies

Deficiency Line # = (Location / Section Item Number)

Compliance *

Compliant
Compliant with Non-Critical Deficiencies
Non-Compliant

System Diagram: Draw or capture* the system diagram below.

TIP: Draw using Google Keep

Take Photo of System Drawing *

Drag & Drop Files, Choose Files to Upload

*TAKE A PHOTO OF THE SYSTEM DRAWING, DO NOT TAKE A PICTURE OF THE HOOD.

A record of this service is to be maintained on premises for no less than five (5) years and made available for inspection by a member of the local fire department, health department, or other AHJ inspectors. It is the owner/tenant’s responsibility to maintain all fire protection equipment in good working order. It is the responsibility of the cleaning company technician to report all deficiencies immediately to the proper authority having jurisdiction.

Customer Authorized Agent *

Clear Signature

Signature

Service Technician *

Clear Signature

Signature

Lic/CoR/Permit No. *

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JOB SITE RESOURCES

Job Summary and
Completion & Deficiency Report

Job Summary

Completion & Deficiency Report

for Commercial Kitchen Exhaust System Service

Service Completion Checklist

Comments / Deficiencies

System Diagram: Draw or capture* the system diagram below.

JOB SITE RESOURCES

Job Summary andCompletion & Deficiency Report

Job Summary

Completion & Deficiency Report

for Commercial Kitchen Exhaust System Service

Service Completion Checklist

Comments / Deficiencies

System Diagram: Draw or capture* the system diagram below.

Job Summary and
Completion & Deficiency Report