Residential In-Home Assessment
Client Information
Client Name: ______________________________________
Address: __________________________________________
City/ZIP: __________________________________________
Phone: ____________________________________________
Email: _____________________________________________
Assessment Date: ___________________________________
Requested Service Date: _____________________________
Home Information
Square Footage: __________ Levels: __________
Bedrooms: __________ Bathrooms: __________
Home Type:
☐ House ☐ Apartment ☐ Condo ☐ Townhome ☐ Duplex ☐ Rental ☐ Other: __________
Pets: ☐ No ☐ Yes: _________________________________
Children: ☐ No ☐ Yes
Allergies/Sensitivities: ______________________________
Medical Conditions: _________________________________
Home Access
☐ Client Home
☐ Key
☐ Door Code
☐ Lockbox
☐ Garage Code
☐ Property Manager
☐ Other: __________________
Access/Parking Instructions:
Cleaning History
Last Professional Cleaning:
☐ Within 1 Month
☐ 1–3 Months
☐ 3–6 Months
☐ More Than 6 Months
☐ Never/Unknown
Home regularly maintained by resident? ☐ Yes ☐ No
Service Recommended
☐ Initial Deep Cleaning
☐ Recurring Cleaning
☐ Move-In
☐ Move-Out
☐ Other: __________________
Overall Condition:
☐ Maintained ☐ Moderate Buildup ☐ Heavy Buildup
Kitchen
Check areas requiring attention:
☐ Counters/Backsplash
☐ Sink/Fixtures
☐ Cabinet Exteriors
☐ Appliances
☐ Stove/Cooktop
☐ Floors
☐ Baseboards
☐ Windows/Blinds
☐ Grease Buildup
☐ Pet Hair
☐ Hard Water
☐ Heavy Buildup
Notes:
Bathrooms
| Area | Bath 1 | Bath 2 | Bath 3 |
|---|---|---|---|
| Tub/Shower | ☐ | ☐ | ☐ |
| Glass Shower | ☐ | ☐ | ☐ |
| Toilet | ☐ | ☐ | ☐ |
| Sink/Vanity | ☐ | ☐ | ☐ |
| Hard Water | ☐ | ☐ | ☐ |
| Soap Scum | ☐ | ☐ | ☐ |
| Surface Mildew | ☐ | ☐ | ☐ |
| Heavy Buildup | ☐ | ☐ | ☐ |
Bathroom Notes:
Bedrooms
| Area | Bed 1 | Bed 2 | Bed 3 | Bed 4 | Bed 5 |
|---|---|---|---|---|---|
| Dusting | ☐ | ☐ | ☐ | ☐ | ☐ |
| Baseboards | ☐ | ☐ | ☐ | ☐ | ☐ |
| Windows | ☐ | ☐ | ☐ | ☐ | ☐ |
| Blinds | ☐ | ☐ | ☐ | ☐ | ☐ |
| Ceiling Fan | ☐ | ☐ | ☐ | ☐ | ☐ |
| Flooring/Carpet | ☐ | ☐ | ☐ | ☐ | ☐ |
| Pet Hair | ☐ | ☐ | ☐ | ☐ | ☐ |
| Heavy Buildup | ☐ | ☐ | ☐ | ☐ | ☐ |
Bedroom Notes:
Living & Common Areas
☐ Living Room
☐ Dining Room
☐ Family Room
☐ Hallways
☐ Entryway
☐ Stairs
☐ Office
☐ Laundry Room
Condition
☐ Dust/Cobwebs
☐ Pet Hair
☐ Baseboards
☐ Ceiling Fans/Lights
☐ Windows/Blinds
☐ Flooring/Carpet
☐ Heavy Buildup
Notes:
Additional Add-On Services
☐ Interior Windows
☐ Window Screens
☐ Sliding Glass Door/Patio Screen
☐ Blinds
☐ Refrigerator/Freezer
☐ Interior Cabinets
☐ Interior Drawers
☐ Wall Dusting/Washing
☐ Bed Making
☐ Laundry
☐ Ceiling Fans
☐ Fireplace
☐ Other: ____________________________________________
Tidy-Up Services
☐ Dishes/Dishwasher
☐ Laundry
☐ Bed/Linen Changes
☐ General Tidying
☐ Decluttering
☐ Organization
☐ Closet/Pantry Organization
☐ Garage/Storage Organization
☐ Packing/Unpacking
☐ Donation Sorting
☐ Garbage/Recycling
☐ Other: ____________________________________________
Pre-Existing Conditions
☐ Scratches/Chips
☐ Broken Fixtures
☐ Damaged Flooring
☐ Carpet Damage/Stains
☐ Wall/Paint Damage
☐ Water Damage
☐ Cabinet/Counter Damage
☐ Appliance Damage
☐ Broken Blinds/Windows
☐ Permanent Staining
☐ Rust/Corrosion
☐ Grout/Caulking Damage
Location/Notes:
Photos Taken: ☐ Yes ☐ No
Unsafe Working Conditions
☐ No Running Water
☐ No Electricity
☐ Exposed/Faulty Wiring
☐ Structural Damage
☐ Unsafe Floors/Holes
☐ Dry Rot
☐ Unsafe Stairs/Railings
☐ Blocked Walkways
☐ Broken/Painted-Shut Emergency Windows
☐ Unsafe Indoor Temperature
☐ No Working Heat/AC
☐ Suspected Asbestos
☐ Hazardous Mold
☐ Sewage
☐ Human/Animal Urine or Feces
☐ Blood/Bodily Fluids/Needles
☐ Rodent/Pest Infestation
☐ Fire/Smoke/Chemical Hazard
☐ Aggressive/Unsecured Pets
☐ Other: ____________________________________________
Safety Decision
☐ Safe to Clean
☐ Condition Must Be Corrected
☐ Professional Remediation Required
☐ Service Declined
Notes:
Client’s Top Priorities
1. _________________________________________________
2. _________________________________________________
3. _________________________________________________
Areas NOT to Clean:
Assessment Summary
Estimated Labor Hours: ______________________________
Recommended Service: _______________________________
Recommended Frequency:
☐ Weekly ☐ Bi-Weekly ☐ Monthly ☐ One-Time
Additional Services: _________________________________
Additional Notes:
Client Acknowledgment
This assessment documents visible conditions at the time of the walkthrough and is used to develop the client’s customized cleaning plan and estimate. Actual cleaning time may vary based on conditions discovered during service.
Client Signature: ________________________ Date: __________
Halo Signature: __________________________ Date: __________