DSS Waste Form
Please read and understand the information below BEFORE proceeding
This form is to track items that were made from the DSS screen that were not actually placed as an order. If the items were made and then used for another order they can NOT be entered on this form. The determination of whether the items entered will count towards a credit of food variance will be made by the Supervisor and/or the leadership team. By entering items into this form you are certifying that these items were actually made and were not able to be used for a customer's order. Credit requests MUST be submitted on the same business day that they occurred in order to be considered.
By choosing to proceed you acknowledge the statement above
Store Number
*
Please Select
1335
1336
4260
4270
4271
4272
4279
4281
4282
4287
4290
4291
4292
4295
4352
8093
8495
Email
Supervisor Email
*
Date
*
-
Month
-
Day
Year
Date
DSS Items Wasted
prev
next
( X )
Cheese or 1 Topping Pizza
$
1.30
Quantity
0
1
2
3
4
5
6
7
8
9
10
Size
Small
Medium
Large
Pan
Item subtotal:
$
0.00
Specialty Pizza
$
2.11
Quantity
0
1
2
3
4
5
6
7
8
9
10
Size
Small
Medium
Large
Pan
Item subtotal:
$
0.00
Pasta
$
2.03
Quantity
0
1
2
3
4
5
6
7
8
9
10
Style
Bread Bowl
Tin
Traditional Wings
$
3.30
Quantity
0
1
2
3
4
5
6
7
8
9
10
Size
8 Piece
10 Piece
Boneless Wings
$
2.21
Quantity
0
1
2
3
4
5
6
7
8
9
10
Size
8 Piece
10 Piece
32 Piece
Specialty Chicken
$
1.86
Quantity
0
1
2
3
4
5
6
7
8
9
10
Size
12 Piece
Bread Sides and Sandwiches
$
2.50
Type
Quantity
Price
Marbled Cookie Brownie
0
1
2
3
4
5
6
7
8
9
10
$
2.50
Cheesybread
0
1
2
3
4
5
6
7
8
9
10
$
1.55
Sandwich
0
1
2
3
4
5
6
7
8
9
10
$
1.73
Parm Bites
0
1
2
3
4
5
6
7
8
9
10
$
0.71
Twists
0
1
2
3
4
5
6
7
8
9
10
$
0.93
3 pc lava cakes
0
1
2
3
4
5
6
7
8
9
10
$
2.32
Tots
0
1
2
3
4
5
6
7
8
9
10
$
1.94
SM cheese
MD Cheese
LG Cheese
Pan Cheese
SM 2T
MD 2T
LG 2T
Pan 2T
SM Specialty
MD Specialty
LG Specialty
PAN Specialty
8 TW
10 TW
16 TW
32 TW
8 BW
10 BW
16 BW
32 BW
Specialty ckn
MCB
SCB
OBS
PBB
Twists
CLCC
Bbowl Pasta
Tots
Tin Pasta
Take Photo
*
Take Photo
Take Photo
Take Photo
Take Photo
Take Photo
Take Photo
Quantity
1
Item
Please Select
Small cheese or 1 topping
Medium cheese or 1 topping
Large cheese or 1 topping
Pan cheese or 1 topping
Small 2 topping
Medium 2 topping
Large 2 topping
Pan 2 topping
Small Specialty
Medium Specialty
Large Specialty
Pan Specialty
Specialty Chicken
8pc Wings
10pc Wings
16pc Wings
32pc Wings
8pc Boneless
10pc Boneless
16pc Boneless
32pc Boneless
Tin Pasta
Breadbowl Pasta
Oven Baked Sandwich
16pc Parm Bites
Bread Twists
Cheesybread
Brownie
3pc Lava Cakes
Tots
1
Cost per item
1
Total for this section
1
Quantity
Item
Please Select
Small cheese or 1 topping
Medium cheese or 1 topping
Large cheese or 1 topping
Pan cheese or 1 topping
Small 2 topping
Medium 2 topping
Large 2 topping
Pan 2 topping
Small Specialty
Medium Specialty
Large Specialty
Pan Specialty
Specialty Chicken
8pc Wings
10pc Wings
16pc Wings
32pc Wings
8pc Boneless
10pc Boneless
16pc Boneless
32pc Boneless
Tin Pasta
Breadbowl Pasta
Oven Baked Sandwich
16pc Parm Bites
Bread Twists
Cheesybread
Brownie
3pc Lava Cakes
Tots
Cost per item
Total for this section
Quantity
Item
Please Select
Small cheese or 1 topping
Medium cheese or 1 topping
Large cheese or 1 topping
Pan cheese or 1 topping
Small 2 topping
Medium 2 topping
Large 2 topping
Pan 2 topping
Small Specialty
Medium Specialty
Large Specialty
Pan Specialty
Specialty Chicken
8pc Wings
10pc Wings
16pc Wings
32pc Wings
8pc Boneless
10pc Boneless
16pc Boneless
32pc Boneless
Tin Pasta
Breadbowl Pasta
Oven Baked Sandwich
16pc Parm Bites
Bread Twists
Cheesybread
Brownie
3pc Lava Cakes
Tots
Cost per item
Total for this section
Quantity
Item
Please Select
Small cheese or 1 topping
Medium cheese or 1 topping
Large cheese or 1 topping
Pan cheese or 1 topping
Small 2 topping
Medium 2 topping
Large 2 topping
Pan 2 topping
Small Specialty
Medium Specialty
Large Specialty
Pan Specialty
Specialty Chicken
8pc Wings
10pc Wings
16pc Wings
32pc Wings
8pc Boneless
10pc Boneless
16pc Boneless
32pc Boneless
Tin Pasta
Breadbowl Pasta
Oven Baked Sandwich
16pc Parm Bites
Bread Twists
Cheesybread
Brownie
3pc Lava Cakes
Tots
Cost per item
Total for this section
Quantity
Item
Please Select
Small cheese or 1 topping
Medium cheese or 1 topping
Large cheese or 1 topping
Pan cheese or 1 topping
Small 2 topping
Medium 2 topping
Large 2 topping
Pan 2 topping
Small Specialty
Medium Specialty
Large Specialty
Pan Specialty
Specialty Chicken
8pc Wings
10pc Wings
16pc Wings
32pc Wings
8pc Boneless
10pc Boneless
16pc Boneless
32pc Boneless
Tin Pasta
Breadbowl Pasta
Oven Baked Sandwich
16pc Parm Bites
Bread Twists
Cheesybread
Brownie
3pc Lava Cakes
Tots
Cost per item
Total for this section
Grand total for all items
File Upload
Browse files or click here to take a photo
Drag and drop files here
Choose a file
Cancel
of
Name of the person submitting this form
*
Comments
Submit
Should be Empty: