Virtual Restaurant Survey

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Store Number (5 digits)* This field is required.
4
Store Address & State* This field is required.
Street Address
Street Address Line 2
City
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Select a Building/Exterior Type* This field is required.
Freestanding - Modernized
Freestanding - Not Modernized
Oil Alliance / Gas
Other
6
Overall Impression of Building Appearance* This field is required.
Great
Good
Average
Needs Improvement
N/A
7
Survey Type* This field is required.Choose "Customer & Property Safety" for Package surveys and choose "Worker Safety" for Work Comp Surveys
Customer & Property Safety (Package)
Worker Safety (Workers' Compensation)
8
Are all employees REQUIRED to wear Slip Resistant Shoes?* This field is required.
YESNO
9
Are all employees currently working wearing the proper shoes?* This field is required.
YESNO
10
Where do employees purchase shoes?* This field is required.
Shoes For Crews
Sketchers
Walmart
Other
11
Are face shields, aprons, & gloves available for cleaning fryers and grills?* This field is required.
YESNO
12
Is personal protective equipment in good condition?* This field is required.
YESNO
13
Attach a picture of P.P.E. storage area* This field is required.Provide a photo of the area where you store your face shield, apron and gloves
Drag and drop files here
Select files to upload
Cancelof
14
Is personal protective equipment required by management when performing dangerous tasks?* This field is required.
YESNO
15
Are floor tiles in good condition? No cracked or missing tiles* This field is required.
YESNO
16
Attach a picture of kitchen floors* This field is required.Provide an overall photo of the floor
Drag and drop files here
Select files to upload
Cancelof
17
Attach a picture of dry storage area floors* This field is required.Provide an overall photo of the dry storage area focused on the floor
Drag and drop files here
Select files to upload
Cancelof
18
Attach a picture of the dry storage area* This field is required.Provide an overall photo of the dry storage area focused on the storage shelves
Drag and drop files here
Select files to upload
Cancelof
19
Are walkways free of empty boxes, bun carts, cords or anything else that could cause a trip & fall?* This field is required.
YESNO
20
Are there cameras in the freezer and cooler?* This field is required.
YESNO
21
Are freezer floors free of ice build up and boxes are stacked neatly to avoid falls?* This field is required.
YESNO
22
Attach an overall picture of the freezer interior* This field is required.
Drag and drop files here
Select files to upload
Cancelof
23
Overall Condition of Parking Lot* This field is required.
Good
Average
Needs Improvement
N/A
24
Any parking lot comments? List any outstanding maintenance items noted in the parking lot
Huge
Large
Normal
Small
Ok
Ok
25
Parking Lot PictureProvide one overall photo of the parking or drive lane on each side of the building (You can add up to 4 pictures)
Drag and drop files here
Select files to upload
Cancelof
26
Is drive thru equipment protected by bollards?* This field is required.Bollards are typically the yellow posts installed to prevent vehicles from damaging your equipment, building, and storefront windows
Yes
No
N/A
27
Picture of drive thru equipment2 Pictures Max
Drag and drop files here
Select files to upload
Cancelof
28
Are sidewalks clean and free of any slip or trip hazards?* This field is required.Any uneven surfaces at joints or cracks greater then 1/8" could cause a trip and fall
Yes
No
N/A
29
Sidewalk Picture* This field is required.Two pictures max
Drag and drop files here
Select files to upload
Cancelof
30
How many Wet Floor Cones are up in the lobby?* This field is required.Signs should be located where they can be seen on video
31
Lobby Pictures * This field is required.Main Entrance, Table/Section, Beverage Station, 2nd Entrance - 4 Pictures Max
Drag and drop files here
Select files to upload
Cancelof
32
Is there at least one wet floor cone in each restroom?* This field is required.
YESNO
33
Men's Room - Picture of wet floor sign* This field is required.Provide photo of wet floor sign in restroom
Drag and drop files here
Select files to upload
Cancelof
34
Women's Room - Picture of wet floor sign* This field is required.Provide photo of wet floor sign in restroom
Drag and drop files here
Select files to upload
Cancelof
35
Do you have "A" frame type or Cone style wet floor signs in this location?* This field is required.
Cone Style
"A" Frame
Both
36
Fryers - Are daily, weekly, & monthly maintenance tasks being performed?* This field is required.
Yes
No
Unknown
37
Fryers - Do you have LOV (low oil volume) fryers?* This field is required.
Yes
No
Partial
Unknown
38
Fryers - Are all Ansul nozzle caps secured to nozzles?* This field is required.
Yes
No
Partial
Unknown
39
Picture of French Fry Fryer and Hood* This field is required.Provide an overall photo of the fryer and hood
Drag and drop files here
Select files to upload
Cancelof
40
Picture of Protein Fryer & Hood* This field is required.Provide an overall photo of the fryer and hood
Drag and drop files here
Select files to upload
Cancelof
41
Picture of Ansul Pull Station* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
42
Overall employee culture
1
2
3
4
5
43
Other Information / Observation
Huge
Large
Normal
Small
Ok
Ok
44
Opportunities to improve (consider this)
Huge
Large
Normal
Small
Ok
Ok
45
Other picture(s), Any hazardous conditions that need to be addressedYou can add up to 4 pictures
Drag and drop files here
Select files to upload
Cancelof
Should be Empty: