EmailMe Form - BED BUGS CONTROL FORM / Reminder EMF

Today's Date *

MM / DD / YYYY

Your Name *

Your Email

ACKNOWLEDGEMENTS*************************

Bed Bugs *

I understand that the presence of bedbugs has been detected in the home I am being assigned to.

Information about bedbugs *

I clicked the link provided and read about the basics about bedbugs as per CDC (Centers for Disease Control).

Bedbugs in your home *

If I am aware of any bedbugs in my home (past, present or future) I will inform the agency asap and seek advice and assistance.

Home Inspection *

I agree to a home inspection from a licensed exterminator chosen by Home Instead Senior Care. This is done to protect my family and my clients. If bedbugs are found in my home, a treatment will be scheduled and costs will be covered by HISC.

Bedbugs in home of any other client *

If I am aware of any bedbugs in the home of any other client (past, present or future) I will inform the agency asap so this is dealt with automatically.

I. UPON ARRIVAL*************************

Personal Items *

I will change into my nurses uniform and take all my personal belongings (jacket, bag, wallet and other items) and place them in a secure plastic bag upon entering my clients home.

Plastic bag *

The plastic bag will be placed on a surface that is not wood or carpet (kitchen counter or even the bathtub is fine).

Nurses aide uniform *

Throughout the day, I will wear my nurses aide uniform and everything else will be in the plastic bag .

II. DURING YOUR SHIFT*************************

Mattress cover *

Every bed that is used in the home must have a BB mattress cover. Check the mattress for one, if you are not sure, ask the other caregivers or our office.

Bed Bug Coaster Trap (see image below) *

Every bed and sofa that is used in the home must have coaster traps on the legs. See image below. If not, call office and we will order them.

People who come in *

Unless you are told otherwise, make sure to let anyone who walks into the home about the presence of bedbugs and inform the office as to who is coming in so we can tell them also.

LAUNDRY

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Bed sheets *

Make sure the sheets are washed in hot water and then dried in the highest heating setting for 45 minutes every week.

III. END OF DAY

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Uniform *

I will change into my street clothing & take my uniform & put it in the plastic bag. I will then either leave the uniform in the home or take it home with me in the sealed bag.

Plastic Bag *

I understand the plastic bag can be any bag as long as it has no holes and it can be tied and then opened up the next time I need it.

Relief caregiver *

I understand to make sure they know to do the same with their personal belongings and plastic bag.

Signature *

Clear

Sign your name with mouse or with your finger

Any questions? Call us at 212-614-8057 or email us at *