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Problem
Proper Needle Disposal
MA Disposal Sites
The Zeedle
Home
Dual Kiosk
About
What We Do
The Team
Find Near You
Contact
Pricing
FAQs
Zeedle Operation
Solution
Press Releases
Blog
Free Education Materials
Submit Work Order Request
Problem
Proper Needle Disposal
MA Disposal Sites
Kiosk Cleaning Review Form
Date of Cleaning
*
MM
DD
YYYY
Picture
Did you take a photo of the kiosk? Please email it to Cherie@MyZeedle.com
Yes
No
Site Name
*
Site Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Serial Number
Label
Is there a label inside the back panel?
Yes
No
Batteries
*
What is the state of the kiosk batteries?
Dead
Alive
Left Set of 4 C Batteries
Batteries
*
Did you change the batteries?
Yes
No
Electronic Panel
Which electronic panel is being used?
Old Panel
New Panel
Not Sure
Kiosk Type
*
Is this a basic or electronic model kiosk?
Basic Model
Electronic Model
Spill Kit
*
Does the kiosk still have a spill kit?
Yes
No
Left a New Spill Kit
Spill Kit Needs to be Mailed to Address Provided
Orange Label
Is there an orange label on the front of the kiosk?
Yes
No
Roll Bucket
Does the kiosk have a roll bucket?
Yes
No
Kiosk Inspection: Body
*
In what condition is the body of the kiosk?
Excellent
Good
Fair
Poor
Kiosk Inspection: Paint
*
What is the condition of the paint on the kiosk?
Excellent
Needs Repainting
Roll Bucket Chipping
Kiosk Inspection: Artwork
*
What is the condition of the artwork on the kiosk?
Excellent
Good
Fair
Poor
None
Kiosk Inspection: Bucket Door
*
Is the roll bucket operational?
Closes all of the way
Door stays open less than 1"
Door stays open more than 1"
Site Remarks
What was the overall condition of the kiosk? Did you encounter any difficulties?
Representative
First Name
Last Name
Thank you!