Facilities Checklist Form

The following information is to assist Germ Solutions and you in determining a custom fit order for your organization’s needs; each facility, building and office are unique and we want to be mindful of that. The

SafeHandles™ products we offer come in various standard sizes to meet your requirements. Please use the information below to create a proper assessment of the areas you would like protected:

Identify entry and egress points – assesses how germs enter and leave the building Look for High Traffic and High Touch-point areas – identifies areas to mitigate Tally up all, door handles, doorknobs, faucet handles & knobs, toilet & urinal handles, grab bars,

railings, push plates, pull handles, ADA door push pads and elevator buttons. Business Name: ___________________________________________________________________________ Address: _________________________________________________________________________________ City: __________________________________________ State: ________ Zip Code: ____________________ Contact Person: _____________________________________ Position: _____________________________ Phone: _________________________________ Email: ___________________________________________ Do you know the square ft. of your facility? Y / N Square Ft.: ________________ Number of floors: ______ Please provide the following information as best as you can so that we may customize your order and deliver the products to suit your needs (Keep in mind that handles and door knobs come in various sizes):

SafeHandles™ Ster-Roll Tape can be used in a variety of locations including Push Bars, ADA Bars, Stair Rails, Push Plates, Appliance Handles and can be cut to fit most heavily touched surfaces. Rolls are available in 2″, 3” and 4″ widths and lengths of 20′ and 75′ and fit on standard packing tape dispensers. SafeHandles™ Ster-Roll Tape is available in clear.

*Please submit this form to your Sales Rep. so that they may customize your order* Germ Solutions, LCC ► 866.919.GERM (4376) ► Info@GermSolutions.com

Ster-Roll Tape 20’ 75’ 2” 3” 4”

Elevator Button Covers

Size: ¾” or 1” Total ADA Push Pads Size: 4” Total

GS-FCL – August 2020