Clone of Restaurant Feedback Form

1
Date of Visit* This field is required.
Date
Year
Month
Day
2
Location* This field is required.Put Name of Restaurant in First Block
Street Address
Street Address Line 2
City
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
3
Time Arrived* This field is required.
1
2
3
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5
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7
8
9
10
11
12
Hour
00
10
20
30
40
50
Minutes
AM
AM
PM
4
Estimated Occupancy Percentage Upon Arrival* This field is required.
5
Time Departed* This field is required.
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
10
20
30
40
50
Minutes
AM
AM
PM
6
Estimated Occupancy Percentage Upon Departure* This field is required.
7
Host/Hostess/Greeter Description* This field is required.Host/Hostess/Greeter
Was there a designated Host/Hostess/Greeter? - If no host/hostess/greeter enter N/A
Host/Hostess/Greeter Description (gender, approx. age & height, hair color) - If no host/hostess/greeter enter N/A
8
Host/Hostess/Greeter * This field is required.Host/Hostess/Greeter
YES
NO
N/A
Were you greeted within 60 seconds with a smile, eye contact, and a friendly demeanor?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Were you made to feel welcome and seated efficiently and courteously?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Were the menus clean, in good condition, and placed in front of each guest after you were seated?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Did the host/hostess/greeter make a comment to enjoy your meal or any other personal touch?
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Was the silverware given to you when you were seated?
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Was the host/hostess/greeter dress attire clean and neat?
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Were departing guests recognized and thanked by a team member?
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
If not seated immediately, were you placed on a wait list, and were you seated at the time quoted? (Add how long in comments)
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Were you greeted within 60 seconds with a smile, eye contact, and a friendly demeanor?
Were you made to feel welcome and seated efficiently and courteously?
Were the menus clean, in good condition, and placed in front of each guest after you were seated?
Did the host/hostess/greeter make a comment to enjoy your meal or any other personal touch?
Was the silverware given to you when you were seated?
Was the host/hostess/greeter dress attire clean and neat?
Were departing guests recognized and thanked by a team member?
If not seated immediately, were you placed on a wait list, and were you seated at the time quoted? (Add how long in comments)
YES
Row 0, Column 0
NO
Row 0, Column 1
N/A
Row 0, Column 2
YES
Row 1, Column 0
NO
Row 1, Column 1
N/A
Row 1, Column 2
YES
Row 2, Column 0
NO
Row 2, Column 1
N/A
Row 2, Column 2
YES
Row 3, Column 0
NO
Row 3, Column 1
N/A
Row 3, Column 2
YES
Row 4, Column 0
NO
Row 4, Column 1
N/A
Row 4, Column 2
YES
Row 5, Column 0
NO
Row 5, Column 1
N/A
Row 5, Column 2
YES
Row 6, Column 0
NO
Row 6, Column 1
N/A
Row 6, Column 2
YES
Row 7, Column 0
NO
Row 7, Column 1
N/A
Row 7, Column 2
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9
Was host/hostess/greeter friendly yet professional throughout the visit? On a scale of 1-5 (1 = lowest; 5 = highest)* This field is required.Host/Hostess/Greeter
1
2
3
4
5
Lowest
Highest
10
Comments on Host/Hostess/Greeter (all no answers need to have a comment) * This field is required.Please leave a minimum of 1-3 sentences.
Huge
Large
Normal
Small
Ok
Ok
11
Server Name & Description* This field is required.Server
Server Name
Server Description (gender, approx. age & height, hair color)
12
Server * This field is required.
YES
NO
NA
Did the server greet you within 60 seconds and mention their name?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Was server dress attire clean & neat?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Was the server friendly, courteous, and smiling? (If not, please provide information in comments)
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Were you asked if you had been to Sunshine Breakfast Bar before?
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Did the server greet you without water? (If given water note in comments)
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Did server suggest 2 specific drinks? (not water)
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Did the server request an ID check if you or your guest appeared under 21 and ordered an alcoholic beverage?
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Was the server using a jigger? (N/A if didn't sit at the bar
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Were drink orders taken and delivered promptly? (Add how long in comments)
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Did the server make any recommendations?
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Did the server recommend or offer any add-ons such as bacon, sausage, ranchero, extra egg, or shareable items? (please provide what they offered in comments)
Row 10, Column 0
Row 10, Column 1
Row 10, Column 2
Did you ask your server questions regarding your food and beverage preferences?
Row 11, Column 0
Row 11, Column 1
Row 11, Column 2
Did the server repeat back your order?
Row 12, Column 0
Row 12, Column 1
Row 12, Column 2
Did the server check back to see if the food was prepared correctly after two bites?
Row 13, Column 0
Row 13, Column 1
Row 13, Column 2
Were all reasonable requests accomodated?
Row 14, Column 0
Row 14, Column 1
Row 14, Column 2
Were beverages refilled as needed?
Row 15, Column 0
Row 15, Column 1
Row 15, Column 2
Were all plates cleared in a timely manner?
Row 16, Column 0
Row 16, Column 1
Row 16, Column 2
Were the correct drinks and food on the check?
Row 17, Column 0
Row 17, Column 1
Row 17, Column 2
Was the payment picked up and processed within 2-5 minutes? (Add how long in comments)
Row 18, Column 0
Row 18, Column 1
Row 18, Column 2
Was the receipt returned within 2 minutes of the payment being processed?
Row 19, Column 0
Row 19, Column 1
Row 19, Column 2
Did the server offer a sincere thank you and were you asked to return?
Row 20, Column 0
Row 20, Column 1
Row 20, Column 2
Based on this visit would you ask for this server again?
Row 21, Column 0
Row 21, Column 1
Row 21, Column 2
Did the server greet you within 60 seconds and mention their name?
Was server dress attire clean & neat?
Was the server friendly, courteous, and smiling? (If not, please provide information in comments)
Were you asked if you had been to Sunshine Breakfast Bar before?
Did the server greet you without water? (If given water note in comments)
Did server suggest 2 specific drinks? (not water)
Did the server request an ID check if you or your guest appeared under 21 and ordered an alcoholic beverage?
Was the server using a jigger? (N/A if didn't sit at the bar
Were drink orders taken and delivered promptly? (Add how long in comments)
Did the server make any recommendations?
Did the server recommend or offer any add-ons such as bacon, sausage, ranchero, extra egg, or shareable items? (please provide what they offered in comments)
Did you ask your server questions regarding your food and beverage preferences?
Did the server repeat back your order?
Did the server check back to see if the food was prepared correctly after two bites?
Were all reasonable requests accomodated?
Were beverages refilled as needed?
Were all plates cleared in a timely manner?
Were the correct drinks and food on the check?
Was the payment picked up and processed within 2-5 minutes? (Add how long in comments)
Was the receipt returned within 2 minutes of the payment being processed?
Did the server offer a sincere thank you and were you asked to return?
Based on this visit would you ask for this server again?
YES
Row 0, Column 0
NO
Row 0, Column 1
NA
Row 0, Column 2
YES
Row 1, Column 0
NO
Row 1, Column 1
NA
Row 1, Column 2
YES
Row 2, Column 0
NO
Row 2, Column 1
NA
Row 2, Column 2
YES
Row 3, Column 0
NO
Row 3, Column 1
NA
Row 3, Column 2
YES
Row 4, Column 0
NO
Row 4, Column 1
NA
Row 4, Column 2
YES
Row 5, Column 0
NO
Row 5, Column 1
NA
Row 5, Column 2
YES
Row 6, Column 0
NO
Row 6, Column 1
NA
Row 6, Column 2
YES
Row 7, Column 0
NO
Row 7, Column 1
NA
Row 7, Column 2
YES
Row 8, Column 0
NO
Row 8, Column 1
NA
Row 8, Column 2
YES
Row 9, Column 0
NO
Row 9, Column 1
NA
Row 9, Column 2
YES
Row 10, Column 0
NO
Row 10, Column 1
NA
Row 10, Column 2
YES
Row 11, Column 0
NO
Row 11, Column 1
NA
Row 11, Column 2
YES
Row 12, Column 0
NO
Row 12, Column 1
NA
Row 12, Column 2
YES
Row 13, Column 0
NO
Row 13, Column 1
NA
Row 13, Column 2
YES
Row 14, Column 0
NO
Row 14, Column 1
NA
Row 14, Column 2
YES
Row 15, Column 0
NO
Row 15, Column 1
NA
Row 15, Column 2
YES
Row 16, Column 0
NO
Row 16, Column 1
NA
Row 16, Column 2
YES
Row 17, Column 0
NO
Row 17, Column 1
NA
Row 17, Column 2
YES
Row 18, Column 0
NO
Row 18, Column 1
NA
Row 18, Column 2
YES
Row 19, Column 0
NO
Row 19, Column 1
NA
Row 19, Column 2
YES
Row 20, Column 0
NO
Row 20, Column 1
NA
Row 20, Column 2
YES
Row 21, Column 0
NO
Row 21, Column 1
NA
Row 21, Column 2
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13
Runner- Food Delivery* This field is required.Food Delivery
YES
NO
NA
Was the food delivered within 15 minutes or less of ordering? (Add how long in comments)
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Was the food delivered with a smile and a greeting?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
When the food was delivered was it announced by name?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Were the outside rims of the plates clean?
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Did the food runner ask if any other items were needed before leaving the table after delivering the food?
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Was the food delivered within 15 minutes or less of ordering? (Add how long in comments)
Was the food delivered with a smile and a greeting?
When the food was delivered was it announced by name?
Were the outside rims of the plates clean?
Did the food runner ask if any other items were needed before leaving the table after delivering the food?
YES
Row 0, Column 0
NO
Row 0, Column 1
NA
Row 0, Column 2
YES
Row 1, Column 0
NO
Row 1, Column 1
NA
Row 1, Column 2
YES
Row 2, Column 0
NO
Row 2, Column 1
NA
Row 2, Column 2
YES
Row 3, Column 0
NO
Row 3, Column 1
NA
Row 3, Column 2
YES
Row 4, Column 0
NO
Row 4, Column 1
NA
Row 4, Column 2
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Did the server give you an experience worth returning for? On a scale of 1-5 (1 = lowest; 5 = highest)* This field is required.Server
1
2
3
4
5
Lowest
Highest
15
Comments on Server & Runner* This field is required.Please leave a minimum of 3-5 sentences - All 'NO' answers need to be explained in the comments
Huge
Large
Normal
Small
Ok
Ok
16
Beverages* This field is required.
Beverage 1
Beverage 2
17
Beverages - Rate 1-5 (1=lowest; 5=highest)* This field is required.
Beverage 1
Beverage 2
Presentation
1
2
3
4
5
N/A
Row 0, Column 0
1
2
3
4
5
N/A
Row 0, Column 1
Quality/Taste/Freshness
1
2
3
4
5
N/A
Row 1, Column 0
1
2
3
4
5
N/A
Row 1, Column 1
Value
1
2
3
4
5
N/A
Row 2, Column 0
1
2
3
4
5
N/A
Row 2, Column 1
Presentation
Quality/Taste/Freshness
Value
Beverage 1
1
2
3
4
5
N/A
Row 0, Column 0
Beverage 2
1
2
3
4
5
N/A
Row 0, Column 1
Beverage 1
1
2
3
4
5
N/A
Row 1, Column 0
Beverage 2
1
2
3
4
5
N/A
Row 1, Column 1
Beverage 1
1
2
3
4
5
N/A
Row 2, Column 0
Beverage 2
1
2
3
4
5
N/A
Row 2, Column 1
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Entrees* This field is required.
Entree 1
Entree 2
19
Entrees - Rate 1-5 (1=lowest; 5=highest)* This field is required.
Entrée 1
Entrée 2
Presentation
1
2
3
4
5
N/A
Row 0, Column 0
1
2
3
4
5
N/A
Row 0, Column 1
Quality/Taste/Freshness
1
2
3
4
5
N/A
Row 1, Column 0
1
2
3
4
5
N/A
Row 1, Column 1
Value
1
2
3
4
5
N/A
Row 2, Column 0
1
2
3
4
5
N/A
Row 2, Column 1
Presentation
Quality/Taste/Freshness
Value
Entrée 1
1
2
3
4
5
N/A
Row 0, Column 0
Entrée 2
1
2
3
4
5
N/A
Row 0, Column 1
Entrée 1
1
2
3
4
5
N/A
Row 1, Column 0
Entrée 2
1
2
3
4
5
N/A
Row 1, Column 1
Entrée 1
1
2
3
4
5
N/A
Row 2, Column 0
Entrée 2
1
2
3
4
5
N/A
Row 2, Column 1
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Entree* This field is required.
YES
NO
N/A
Were all modifications and/or special requests made to entree items correct?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Overall were entrees prepared correctly?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Overall were entrees prepared at the correct temperature?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Were all modifications and/or special requests made to entree items correct?
Overall were entrees prepared correctly?
Overall were entrees prepared at the correct temperature?
YES
Row 0, Column 0
NO
Row 0, Column 1
N/A
Row 0, Column 2
YES
Row 1, Column 0
NO
Row 1, Column 1
N/A
Row 1, Column 2
YES
Row 2, Column 0
NO
Row 2, Column 1
N/A
Row 2, Column 2
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Were the food/beverage items desirable and to your satisfaction? On a scale of 1-5 (1 = lowest; 5 = highest)* This field is required.
1
2
3
4
5
Lowest
Highest
22
Comments on Beverages and Food Items* This field is required.Please leave a minimum of 6-8 sentences - Don't forget to attach pictures of food, drink(s) and restaurant receipts (itemized list and purchase total receipts).
Huge
Large
Normal
Small
Ok
Ok
23
Manager Description* This field is required.
Was a manager visible? - If no manager visible enter N/A
Manager Description (gender, approx. age & height, hair color) - If no manager visible enter N/A
24
Manager (if no manager check no on all questions)* This field is required.
YES
NO
N/A
Was a manager visible in the restaurant?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
If a manager visited your table, did he or she introduce themselves?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Was the manager professional and friendly?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Was the manager visiting other tables?
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Did the manager interact with customers and team members pleasantly and helpfully?
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
If you had a problem, did manager speak to you?
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Were you compensated for any problem?
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Was a manager visible in the restaurant?
If a manager visited your table, did he or she introduce themselves?
Was the manager professional and friendly?
Was the manager visiting other tables?
Did the manager interact with customers and team members pleasantly and helpfully?
If you had a problem, did manager speak to you?
Were you compensated for any problem?
YES
Row 0, Column 0
NO
Row 0, Column 1
N/A
Row 0, Column 2
YES
Row 1, Column 0
NO
Row 1, Column 1
N/A
Row 1, Column 2
YES
Row 2, Column 0
NO
Row 2, Column 1
N/A
Row 2, Column 2
YES
Row 3, Column 0
NO
Row 3, Column 1
N/A
Row 3, Column 2
YES
Row 4, Column 0
NO
Row 4, Column 1
N/A
Row 4, Column 2
YES
Row 5, Column 0
NO
Row 5, Column 1
N/A
Row 5, Column 2
YES
Row 6, Column 0
NO
Row 6, Column 1
N/A
Row 6, Column 2
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25
Comments on Manager (all no answers need to have a comment)* This field is required.Please leave a minimum of 2-3 sentences (if applicable). - If no manager, type N/A in comments.
Huge
Large
Normal
Small
Ok
Ok
26
Facilities* This field is required.
YES
NO
N/A
Was the signage visible and functioning properly?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Were the front windows/door clean and well maintained?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Were the patio heaters/misters in use? (if necessary)
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Were the restaurant chairs and tables clean and neatly arranged?
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Were restaurant and patio tables bussed and cleaned as guests left?
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Were the floors clean, well maintained, and free of debris?
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Were the televisions on and the volume muted?
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Was the lighting and music at a comfortable level?
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Was the temperature at a comfortable level?
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Were all ceiling vents clean and in good repair?
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Were the silverware and dishes clean?
Row 10, Column 0
Row 10, Column 1
Row 10, Column 2
Were all dishes and glassware free of chips?
Row 11, Column 0
Row 11, Column 1
Row 11, Column 2
Was the signage visible and functioning properly?
Were the front windows/door clean and well maintained?
Were the patio heaters/misters in use? (if necessary)
Were the restaurant chairs and tables clean and neatly arranged?
Were restaurant and patio tables bussed and cleaned as guests left?
Were the floors clean, well maintained, and free of debris?
Were the televisions on and the volume muted?
Was the lighting and music at a comfortable level?
Was the temperature at a comfortable level?
Were all ceiling vents clean and in good repair?
Were the silverware and dishes clean?
Were all dishes and glassware free of chips?
YES
Row 0, Column 0
NO
Row 0, Column 1
N/A
Row 0, Column 2
YES
Row 1, Column 0
NO
Row 1, Column 1
N/A
Row 1, Column 2
YES
Row 2, Column 0
NO
Row 2, Column 1
N/A
Row 2, Column 2
YES
Row 3, Column 0
NO
Row 3, Column 1
N/A
Row 3, Column 2
YES
Row 4, Column 0
NO
Row 4, Column 1
N/A
Row 4, Column 2
YES
Row 5, Column 0
NO
Row 5, Column 1
N/A
Row 5, Column 2
YES
Row 6, Column 0
NO
Row 6, Column 1
N/A
Row 6, Column 2
YES
Row 7, Column 0
NO
Row 7, Column 1
N/A
Row 7, Column 2
YES
Row 8, Column 0
NO
Row 8, Column 1
N/A
Row 8, Column 2
YES
Row 9, Column 0
NO
Row 9, Column 1
N/A
Row 9, Column 2
YES
Row 10, Column 0
NO
Row 10, Column 1
N/A
Row 10, Column 2
YES
Row 11, Column 0
NO
Row 11, Column 1
N/A
Row 11, Column 2
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27
Was facility clean and inviting throughout the visit? On a scale of 1-5 (1 = lowest; 5 = highest)* This field is required.
1
2
3
4
5
Lowest
Highest
28
Comments on Facilities* This field is required.Please leave a minimum of 3-5 sentences - All 'NO' answers need to be explained in the comments
Huge
Large
Normal
Small
Ok
Ok
29
Restrooms* This field is required.
YES
NO
N/A
Were restroom fixtures (toilets, urinals) clean?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Was the restroom floor clean, free of debris and standing water?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Were the walls clean and well maintained?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Were the trash receptacles clean and not overflowing?
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Were the paper and soap products stocked?
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Were the soap dispensers in working order?
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Were the restrooms odor free?
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Were the restroom lighting fixtures all working?
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Were the ceiling vents clean and in good repair?
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Were restroom fixtures (toilets, urinals) clean?
Was the restroom floor clean, free of debris and standing water?
Were the walls clean and well maintained?
Were the trash receptacles clean and not overflowing?
Were the paper and soap products stocked?
Were the soap dispensers in working order?
Were the restrooms odor free?
Were the restroom lighting fixtures all working?
Were the ceiling vents clean and in good repair?
YES
Row 0, Column 0
NO
Row 0, Column 1
N/A
Row 0, Column 2
YES
Row 1, Column 0
NO
Row 1, Column 1
N/A
Row 1, Column 2
YES
Row 2, Column 0
NO
Row 2, Column 1
N/A
Row 2, Column 2
YES
Row 3, Column 0
NO
Row 3, Column 1
N/A
Row 3, Column 2
YES
Row 4, Column 0
NO
Row 4, Column 1
N/A
Row 4, Column 2
YES
Row 5, Column 0
NO
Row 5, Column 1
N/A
Row 5, Column 2
YES
Row 6, Column 0
NO
Row 6, Column 1
N/A
Row 6, Column 2
YES
Row 7, Column 0
NO
Row 7, Column 1
N/A
Row 7, Column 2
YES
Row 8, Column 0
NO
Row 8, Column 1
N/A
Row 8, Column 2
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30
Comments on Restrooms* This field is required.Please leave a minimum of 2-3 sentences - All 'NO' answers need to be explained in the comments. Make sure to add which restroom you were in (mens, ladies, or unisex). Please submit photo images of any problem areas.
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Large
Normal
Small
Ok
Ok
31
Return* This field is required.
YES
NO
N/A
Based on this visit would you return?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Would you refer this facility / restaurant to your family, friends or coworkers?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Based on this visit would you return?
Would you refer this facility / restaurant to your family, friends or coworkers?
YES
Row 0, Column 0
NO
Row 0, Column 1
N/A
Row 0, Column 2
YES
Row 1, Column 0
NO
Row 1, Column 1
N/A
Row 1, Column 2
1 of 2
32
How pleasant was your experience at this restaurant? On a scale of 1-5 (1 = lowest; 5 = highest)* This field is required.
1
2
3
4
5
Lowest
Highest
33
Comments on Return* This field is required.Please leave a minimum of 3-5 sentences - All 'NO' answers need to be explained in the comments
Huge
Large
Normal
Small
Ok
Ok
34
Upload all Pictures and Receipts Here* This field is required.
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Max. file size: 10.6MB
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35
Please verify that you are human* This field is required.
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