Virtual Restaurant and Bar Survey

1
Survey Type* This field is required.
First Time
Re-Inspect
2
Name* This field is required.
First Name
Last Name
3
Job Title* This field is required.
4
Email Address* This field is required.
example@example.com
5
Phone Number* This field is required.
Please enter a valid phone number.
6
Survey Date* This field is required.
Date
Month
Day
Year
7
Location Name / Store Number or Address* This field is required.
8
Restaurant State* This field is required.
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Conneticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hamshire
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
9
Overall Impression of Building Appearance* This field is required.
Great
Good
Average
Needs Improvement
N / A
10
Overall Condition (Parking Lot)* This field is required.
Good
Average
Needs Improvement
N / A
11
Parking Lot Comments* This field is required.
12
Parking Lot Pictures (Side, Back, etc.)* This field is required.You are able to add up to 4 Pictures
Drag and drop files here
Select files to upload
Cancelof
13
Are sidewalks clean and free of any slip or trip hazards?* This field is required.
Yes
No
N / A
14
Are all areas free of potholes, hazardous cracks, etc.?* This field is required.
Yes
No
N / A
15
For the customer areas, what are the floor surfaces? Tile, carpet, concrete, etc.* This field is required.
16
Do you make use of Wet Floor signs?* This field is required.
Yes
No
N / A
17
Entry/Lobby Picture* This field is required.you are able to add up to 4 pictures
Drag and drop files here
Select files to upload
Cancelof
18
Seating area/Front Counter Picture* This field is required.you are able to add up to 4 pictures
Drag and drop files here
Select files to upload
Cancelof
19
Bar Picture (if applicable)you are able to add up to 4 pictures
Drag and drop files here
Select files to upload
Cancelof
20
Other Information / Observation
21
Opportunities To Improve (consider this)
22
Other Picture(s), Any hazardous conditions that need to be addressed.you are able to add up to 4 pictures
Drag and drop files here
Select files to upload
Cancelof
Should be Empty: