Grocery Store COVID Safety Report

Grocery Store COVID Safety Report
Thank you for helping keep our grocery stores safe for workers, shoppers, and our community!

This report will take about 5-10 minutes to fill out. It uses the internet to save and submit, so if you don’t get a good signal in the store on your phone, you can always fill it out in the parking lot or when you get home, or print out a paper copy and bring it with you to the store.

Please do NOT make special trips to the store to file safety reports—just fill this out when you plan to go shopping anyway. It’s always best to limit your time in the store, try to go at less busy times of day, and only send one member of a household to the store if possible. Remember to wear your mask!

Store Entrance
Is there clear signage about mask requirements?

YesNo
Is there clear signage about store capacity limits?

YesNo
Is there anyone counting customers or visibly managing capacity in any way?

YesNo
Is there a designated entrance and a designated exit?

YesNo

At Checkout
Are customers consistently maintaining 6 feet of distance from each other and the cashier?

YesNo
Is there hand sanitizer available to you at checkout?

YesNo
Are there enough checkstands open to deal with the number of customers in line?

YesNo
How long did you wait in line before you could check out?

Photos

If you have any pictures that help illustrate how clean and safe your store was today, you can upload them here, or email them to us later at grocerystorereport@ufcw21.org. If you don't have any photos to share, just click "Next" to finish the survey.
Picture 1

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Picture 2

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Picture 3

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More Information
Do you have any other comments or thoughts to share about your experience today?
Do you have any message to share with the workers at this store?
Thinking through your overall experience, on a scale of 1-10, how would you rate this store's safety and compliance with COVID regulations today?*

1=lowest level of safety/satisfaction, 5=highest level of safety/satisfaction
Are you a Worker at this store or a Shopper at this store?

I am a Shopper at this storeI am a Worker at this store
Your contact information:

(Optional)
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Should be Empty:

Store Entrance