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!

  • Date of visit:*
     - -

  • Store Entrance

  • Is there clear signage about mask requirements?
  • Is there clear signage about store capacity limits?
  • Is there anyone counting customers or visibly managing capacity in any way?
  • Is there a designated entrance and a designated exit?

  • In the Store

  • Is there anyone continuously sanitizing throughout the store? (This includes carts, shopping baskets, and all frequently touched surfaces)
  • Is the store too crowded to allow for regular social distancing between all customers and staff?
  • Are aisles closed for workers to restock product?
  • Are there one-way aisles to help maintain social distance?
  • Is everyone wearing a mask and wearing it properly over their nose and mouth?
  • Are any self-serve areas open?
  • Are any restaurant/seating areas open?
  • Are areas where workers interact with the public (like coffee counters or delis) providing 6 feet of distance or a physical barrier between customers and staff?

  • At Checkout

  • Are customers consistently maintaining 6 feet of distance from each other and the cashier?
  • Is there hand sanitizer available to you at checkout?
  • Are there enough checkstands open to deal with the number of customers in line?

  • 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.
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  • More Information

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  • Are you a Worker at this store or a Shopper at this store?

  • Your contact information:

    (Optional)

  • Format: (000) 000-0000.
  • Should be Empty: