Facility Name: Contact at Facility

Facility Name: Contact at Facility:

Facility Contact Phone/Email: Date:

Product Name Manufacturer Supplier Amount Used/ Month Dilutio Comments on Product n Rate (RTU=1 :1) Restroom Floors (Non-Sanitizing)

Restroom Floors (Sanitizing)

Restroom Fixtures

Toilet Bowl Cleaners

Disinfections Against Bloodborne Pathogens

Kitchen Countertops

Kitchen Sanitizers (Food Contact)

Product Name Manufacturer Supplier Amount Used/ Month Dilutio Comments on Product n Rate (RTU=1 :1) Air Freshener/Deodorizer

Laundry Sanitizer/Whitener

Hand soap (Antibacterial and Non-antibacterial)

General Purpose Cleaner (Non-disinfecting)

Floors (Non-Restroom)

Carpet Cleaner/Stain Remover

Other (including Specialty Applications)

Thank you for your commitment to creating a healthy school for students and staff! For more information, contact: Timothy Ballard, Director, Maintenance and Inspections, [email protected] Joanna Pi-Sunyer, Green Schools Coordinator, [email protected]