Emergency Disinfection Authorization
Horizon Services Company - Special Disinfection Procedures - Updated 4/1/2020
Important Notice and Acknowledgement Form to Customers:
Attached are the processes and procedures that may be deployed, including staff instructions depending on location and requirement for emergency disinfection services.
For all processes, we do not know of incompatibilities with surfaces and material but cannot be responsible for all or any of the following; streaking, discoloration, staining, wrinkling, damage etc. All materials are EPA registered disinfectants used in the manufacturer’s proper dilutions and applications.
Please note the following preparations and precautions:
-Please notify to Horizon any confirmed or suspected cases of infection and location
-Areas to be disinfected must be empty of prior occupants for at least 24 hours.
-Please indicate customer point of contact and emergency point of contact in notes section below
-Horizon will be the sole determiner of staffing and equipment to perform the disinfection
-Horizon will establish meal and break periods for staff pursuant to State and Federal regulations.
-Horizon to establish all PPE requirements for staff pursuant to State and Federal regulations.
-Please instruct occupants to remove put away and documents and other papers prior to work
-Any doubt about unusual surfaces or situations that may cause damage to customer property may be bypassed.
-Please indicate special areas or access or clearances and credentials in Notes below.
-Understand that due to the nature of disinfection itself, all areas are subject to recontamination immediately upon occupancy.
-Please indicate any other information that may be important, not mentioned above regarding the disinfection service below:
Customer notes for Horizon for disinfection:
I have read and acknowledge work to be performed and accept risks,
Signature, Name and Title Date