Odor Treatment Safety Questionnaire & Consent (Ozone, Hydroxyl & Chemicals)

Safety questions

These keep everyone safe on treatment day. Answer every one — a “heads up” answer does not stop the job, it just tells us how to plan it.

• Does anyone at the property have asthma, COPD, another breathing or heart condition, or is anyone pregnant, an infant or elderly?

  We can still treat — we just plan longer clear-out and aeration time.

  yesno

• Is anyone at the property using oxygen or other home medical equipment?

  yesno

• Are there pets, birds, fish, reptiles or other animals at the property?

  Birds and fish are especially sensitive and must leave the building, not just the room.

  yesno

• Are there live plants in or near the area being treated?

  yesno

• Can everyone — people, pets and plants — be out of the treated area for the whole treatment and until we say the air has cleared?

  yesno

• Is the space attached to another home, apartment or business that shares air, a hallway or ductwork?

  yesno

• Are there rubber or latex items, artwork, photographs, silk plants, leather, electronics, medications or open food that need to be removed first?

  yesno

• Will all food, drink and medication be sealed or removed from the treated area?

  yesno

• Will we have access to the HVAC system, smoke alarms and a key or lockbox code?

  yesno

• Is anyone at the property sensitive or allergic to cleaning chemicals, disinfectants, fragrances or strong scents?

  We can switch to a low-odor or fragrance-free product, or use hydroxyl instead of fogging.

  yesno

• Will anyone need to stay in the building while we treat (for example an attached unit, a business next door or an overnight occupant)?

  If so we use hydroxyl and air scrubbing instead of ozone.

  yesno

• Are there kitchen counters, dishes, cookware, toys or pet bowls in the area we are treating?

  Anything that touches food, a child or a pet gets covered, removed or washed after treatment.

  yesno

• Is there an aquarium, terrarium or beehive that cannot be moved?

  yesno

• Are there antiques, musical instruments, specialty finishes, natural stone or artwork we should protect from chemicals or fogging?

  yesno

• Would you like the Safety Data Sheet (SDS) for the products we use emailed to you?

  Either answer is fine — you can request them at any time.

  yesno

• Will you (owner or tenant) have the area cleaned and prepped — belongings, laundry, trash, food, dishes and litter boxes cleared — before we arrive?

  If you would rather we do the prep cleaning, answer No and we will quote it as an added charge.

  yesno

• Do you understand nobody may re-enter until we confirm the space is clear?

  yesno

Please read and check each item

Tick the box and put your initials beside each one so there is no question later about what was agreed.

• I understand 365 Restoration may use one or more odor treatments: ozone (empty space only), hydroxyl generators (can run while the space is occupied), thermal or ULV fogging, air scrubbing with HEPA and carbon, EPA-registered antimicrobials or disinfectants, enzyme or peroxide cleaners, and sealers or primers on structural surfaces, and that my technician will tell me which is being used and for how long.
• I understand none of these treatments substitute for removing the source of the odor — soot, contaminated materials and wet building materials still have to be cleaned or removed.
• OZONE: breathing ozone can irritate the lungs and worsen asthma, COPD, heart and other breathing conditions. The U.S. EPA states ozone generators are not proven safe or effective in occupied spaces, so ozone is used only in an empty, sealed space.
• Every person, pet, bird, fish, reptile and live plant will be out of the ozone-treated area before treatment starts and will stay out until 365 Restoration tells me the air has cleared — normally at least 2–4 hours of airing after the machines stop, longer on heavy jobs.
• I have removed, or authorize 365 Restoration to remove or cover, items ozone can damage — rubber and latex, elastic, artwork and photographs, silk and live plants, leather, some electronics, medications, open food and drink — and 365 Restoration is not responsible for items I was asked to remove and left in the treated area.
• HYDROXYL: hydroxyl generators are normally safe to run in an occupied space, but they use UV lamps, can produce a slight odor and can still bother someone who is chemically sensitive. If anyone reacts, I will leave the area and call 365 Restoration.
• I will not open, unplug, cover or move any ozone, hydroxyl, air scrubber or drying equipment, and I will keep children and pets away from it.
• CHEMICALS: any antimicrobial, disinfectant, deodorizer, enzyme, peroxide product or sealer used will be EPA-registered or industry standard and applied per its label. I may ask for the Safety Data Sheet (SDS) for any product used at my property at any time.
• I will keep people and pets out of chemically treated areas until surfaces are dry and the area has been aired out, and I will wash any food-contact surface, dish, toy or pet bowl left in a treated area before using it again.
• Fogging, sealers and some cleaners leave a residue or scent for a period of time and can affect finishes, fabrics and some sensitive materials; I have told 365 Restoration about any finish, antique or item that needs to be protected or removed.
• Smoke and fire alarms in the treated area may be covered or muted during treatment and will be uncovered and tested before the space is released back to me.
• PREPARATION IS MINE: cleaning and preparing the area — picking up, removing belongings, laundry, trash, food, dishes, litter boxes and anything on the floors or surfaces — is the responsibility of the homeowner or tenant and must be done before we arrive. 365 Restoration will walk the space with me and explain exactly what needs to be done.
• If the area is not prepared when we arrive, or I ask 365 Restoration to do the prep cleaning, that work is billed as an additional charge at our current rates and may push the treatment to another day.
• Treatment results depend on that prep — odor left in belongings, soiled items or debris that were not removed can hold odor and may require a repeat treatment at additional cost.
• A light odor may remain after treatment and a second treatment or additional cleaning may be needed. This form is not medical advice — if anyone has a health condition that may be affected, I will check with their doctor first.
• I confirm the answers I gave in the safety questions above are accurate and I will tell 365 Restoration right away if anything changes before treatment day.

Virginia law prohibits a contractor from paying, waiving, absorbing or rebating an insurance deductible. Your deductible is your responsibility, and we will never offer to cover it.

If this agreement is signed at your home or anywhere other than our regular place of business, you may cancel it without penalty or obligation within three business days of signing. To cancel, notify us in writing at our office address or by email before midnight of the third business day.

Virginia contractor disclosures

• 365 Restoration is a Virginia licensed Class A contractor, license #2705138091, issued by the Virginia Board for Contractors. Our license class and specialties are shown on the license, which is verifiable at www.dpor.virginia.gov.
• All reconstruction and repair work is performed in accordance with the Virginia Uniform Statewide Building Code (USBC) and the Virginia Residential and Energy Conservation Code provisions it adopts, including insulation, air-sealing and ventilation requirements where the work touches the building envelope or mechanical systems. Required building, electrical, plumbing, mechanical and gas permits are obtained by us or by the licensed trade performing the work, and inspections are scheduled with the local building official before covered work is concealed.
• Contractor Transaction Recovery Fund: if you have a claim against us that a court has reduced to judgment for improper or dishonest conduct in a licensed transaction, you may be eligible for relief from the Virginia Contractor Transaction Recovery Fund. Contact the Board for Contractors at the address above for details, including filing deadlines and limits.
• Virginia Department of Professional and Occupational Regulation, Board for Contractors, 9960 Mayland Drive, Suite 400, Richmond, VA 23233 — (804) 367-8511 — www.dpor.virginia.gov. You may contact the Board to verify our license or to file a complaint. Complaints must generally be filed within the time limits set by Board regulation.

By typing my name and signing below I agree that my electronic signature is the legal equivalent of my handwritten signature on this document. My name, the date and time, and my IP address are recorded with this record.