AFSS 2014 - 52113.

• Jack int the Box AFSS Survey 2014

• Conducted on

  Date

• Store Number

• Audit Title

• Document No.

• Prepared by

• Location
  Address

Exterior

Building Pictures N-S-E-W

• Building Picture North Side

  Media

• Building Picture South Side

  Media

• Building Picture East Side

  Media

• Building Picture West Side.

  Media

Parking Lot

• Type of parking lot surface

  Asphalt w/ some concrete at high impact area

  All concrete

  Other Parking lot material

  Asphalt no Concrete

  Site has no parking lot street parking only

• Parking Lot Striping

  Okay

  Re-Striping needed

  Store has no on site parking

• Condition of Parking lot

  Select Major repairs needed FY14 Major repairs needed FY15 Major repairs needed FY16 Minor repairs and or seal coat needed FY14 Minor repairs and or seal coat needed FY15 Minor repairs and or seal coat needed FY16 Store has no on site parking

  • Major repairs needed FY14
  • Major repairs needed FY15
  • Major repairs needed FY16
  • Minor repairs and or seal coat needed FY14
  • Minor repairs and or seal coat needed FY15
  • Minor repairs and or seal coat needed FY16
  • Store has no on site parking

• Other: Parking lot actions not listed

• Additional Comments on Parking Lot:

• Picture or pictures of parking lot issues or concerns.

  Media

Landscaping

• Condition of Landscape overall

  Select Major Capital needed FY14 Major Capital needed FY15 Major Capital needed FY16 Minor Capital needed Regular Maintenance needed Okay Store has no Landscaping it is a walk up

  • Major Capital needed FY14
  • Major Capital needed FY15
  • Major Capital needed FY16
  • Minor Capital needed
  • Regular Maintenance needed
  • Okay
  • Store has no Landscaping it is a walk up

• Additional Comments on Landscape:

• Picture or Pictures of Landscape issues

  Media

Irrigation timer

• Location of Irrigation Timer?

• Picture or Pictures of Irrigation Timer

  Media

• Additional Comments on Irrigation Timer:

Building exterior (Walls/Fascia/Mansard)

• Condition of the exterior of the building

  Select Minor repairs needed Major repairs needed FY14 Major repairs needed FY15 Major repairs needed FY16 Okay None

  • Minor repairs needed
  • Major repairs needed FY14
  • Major repairs needed FY15
  • Major repairs needed FY16
  • Okay
  • None

• Additional Comments on Building issues:

• Picture or Pictures of building issues:

  Media

Exterior Painting

• Condition of the exterior building paint

  Okay

  Painting needed FY14

  Painting needed FY15

  Painting needed FY16

• Condition of pitched roof paint

  Okay

  Painting needed FY14

  Painting needed FY15

  Painting needed FY16

• Does the building have standard JIB Colors ( I.E balance beige, caviar & fire weed )

  No

  Yes

  Partial

  Newest JIB colors

  Building Matched shopping center It is in

• Additional Comments on Exterior painting condition:

• Picture or Pictures of the building painting

  Media

Fence and Exterior Railing

• Is there a Fence or Railing at this store?

Information on Fence or Railing?

• Condition of Fence or Exterior Railings

  Select Minor repairs needed Major repairs needed FY14 Major repairs needed FY15 Major repairs needed FY16 Okay None

  • Minor repairs needed
  • Major repairs needed FY14
  • Major repairs needed FY15
  • Major repairs needed FY16
  • Okay
  • None

• Additional Comments on Fence or Exterior Railings

• Picture or Pictures of Fence or Railing issue:

  Media

Gas

• Gas supply to building

  Natural Gas

  Liquid Propane

  N/A- All-Elecric

• Picture of Gas meter or Propane tank.

  Media

Glazing ( Window Glass, Doors, Frames)

• Condition of Glass

  Select Okay Minor Repairs Needed Minor Graffiti Major repairs needed FY14 Major repairs needed FY15 Major repairs needed FY16

  • Okay
  • Minor Repairs Needed
  • Minor Graffiti
  • Major repairs needed FY14
  • Major repairs needed FY15
  • Major repairs needed FY16

• Additional Comments on Glass or Doors:

Grease Interceptor

• Type of existing Grease interceptor

  No existing & unit needed

  Interior Unit above grade

  Exterior unit

  Interior unit

• Other: Grease Interceptor issue

• Additional Comments on Grease Interceptor:

• Picture or Pictures of Grease Interceptor location and issues:

  Media

Trash Enclosure

• Condition of Trash Enclosure

  Select Okay Minor repairs needed Gate Replacement Needed Major repairs needed FY 14 Major repairs needed FY 15 Major repairs needed FY 16 Cement apron failure

  • Okay
  • Minor repairs needed
  • Gate Replacement Needed
  • Major repairs needed FY 14
  • Major repairs needed FY 15
  • Major repairs needed FY 16
  • Cement apron failure

• Are all trash/ recycle containers stored within trash enclosure

  Yes

  No

  N/A

• Additional Comments on Trash Enclosure issues:

• Picture or Pictures of Trash Enclosure issues:

  Media

Electrical

• Manufacturer of the existing electrical switch gear

• Amperage of the existing switch gear

  400 Amp

  600 Amp

  800 Amp

  1000 Amp

  1200 Amp

• Voltage of existing switch gear

  120/208

  120/240

• Phase of existing switch gear

  Single Phase

  Three Phase

• Additional Comments on Electrical Switch gear:

• Picture or Pictures of the Electrical Switch gear

  Media

Patio Furniture

• Does site have Patio Furniture

  Yes

  No

  N/A

• Condition of the Patio Furniture

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Picture or Pictures of the Patio Furniture

  Media

• Additional Comments on Patio Furniture

Site Lighting

• Condition of the light poles

  Okay

  Minor repair/work needed

  Major repairs needed FY 14

  Major repairs needed FY 15

  Major repairs needed FY 16

• Additional Comments on Site Lighting

Signage

• Style of exterior Signage

  New Logo

  Old Logo

  Mixed Signage

  City Site Specific

• Are there mismatched colors of paint where poor painting occurred where signage was replaced?

  Yes

  No

  N/A

• Picture or Pictures of mismatched painting from signage installation.

  Media

Picture or Pictures of the tower sign or monument signage.

• Picture or Pictures of the tower sign or monument signage.

  Media

Exterior Menu Board

• Picture or Pictures of the Menu Board and Preview Boards

  Media

• Additional Comments on Menu Board or Preview Board.

Storm Water

• Does restaurant have storm water filteration system?

  Yes

  No

  N/A

• Does restaurant have a Drywell drainage system?

  Yes

  No

  N/A

• If yes, does system drain to a retention pond?

  Yes

  No

  N/A

• Additional Comments on storm water systems:

  Yes

  No

  N/A

• Picture or Pictures of Storm Water Systems.

  Media

Additional Exterior issues or concerns.

• Additional Exterior issues or concerns not addressed or listed in previous questions.

• Picture or Pictures of any Exterior Issues or Conserns.

  Media

Interior Dine Area walls

• Condition of the Dine area walls

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Additional Comments on Dine Area walls

• Picture of each style of wallpaper used on Dine Area walls

  Media

• Picture or Pictures of any damaged wall surfaces in the dine area

  Media

Interior Dine Area ceiling

• Condition of the Dine area Ceiling

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Additional Comments on Dine Area Ceiling

• Picture or Pictures of Dine Area Ceiling

  Media

• Picture or Pictures of Dine Area Ceiling issues

  Media

Interior Dine Area Floor

• Condition of Dine Area Floor

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Additional Comments on Dine Area Floor

• Picture or Pictures of each style of floor tile in Dine Area

  Media

• Picture or Pictures of Dine Room Floor tile issues

  Media

Dining Area Chairs & Bar Stools.

• Count of Chairs in Dine Area?

• Picture or Pictures of Dine Area Chairs.

  Media

• Additional Comments on Dine Area Chairs:

• Count of Bar Stools in Dine Area?

• Picture or Pictures of Dine Area Bar Stools..

  Media

• Additional Comments on Dine Area Chairs:

Women's and Men's Room

• Does restroom have tile on full height of walls?

  No

  Yes

  Partial

• Picture of wall tile in restroom

  Media

• Picture of floor and cove base tile in the restroom

  Media

Decorative railing

• Is there interior railing installed?

  Yes

  No

  N/A

• If yes, does railing have defective finish & require replacement?

  Yes

  No

  N/A

• Picture or Pictures of railing

  Media

• Is there exterior railing installed?

  Yes

  No

  N/A

• Picture or Pictures of the Exterior Railings.

  Media

• If yes, does railing have defective finish & require replacement?

  Yes

  No

  N/A

• Additional Comments on interior or exterior railing:

Dining Room. Cabinets/Counters

• Cabinet/Counter. (Type of self-service cabinet)

  Metal

  Wood/Laminate

  Other

• Is unit on a curb?

  Curb

  Legs

  N/A

• Condition of Self-Serve Unit?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 No self-serve soda station

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • No self-serve soda station

• Picture or Pictures of the Self-Serve unit?

  Media

• Additional Comments on Self-Serve unit?

Ice Machine Dine Self-Service

• Manufacturer if Self-Serve Ice Machine?

  Select Manitowoc Hoshizaki Follett ice-O-Matic Scotsman No Self-Serve Ice Machine

  • Manitowoc
  • Hoshizaki
  • Follett
  • ice-O-Matic
  • Scotsman
  • No Self-Serve Ice Machine

• Manufacturer if Self-Serve Ice Machine? If not listed above.

• Serial number for Self-Serve Ice Machine?

• Type of Ice Machine?

  Remote

  Self Contained

• Condition of the Self-Serve Ice Machine?

  Okay

  Minor repairs needed

  Replace FY14

  Replace FY15

  Replace FY16

• Picture or Pictures of Self-Serve ice Machine.

  Media

• Additional Comments on Self-Serve Ice Machine:

Kitchen

Shake Machine

• Manufacturer of Shake Machine?

  Taylor

• Manufacturer of Shake Machine? If not a Taylor as listed above.

• Serial Number of Shake Machine.

• Condition of Shake Machine?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Picture of Shake Machine

  Media

• Additional Comments on Shake Machine:

Ice Machine - Drive-thru

• Manufacturer of Drive Thru Ice Machine

  Select Manitowoc Hoshizaki Follett ice-O-Matic Scotsman No Self-Serve Ice Machine

  • Manitowoc
  • Hoshizaki
  • Follett
  • ice-O-Matic
  • Scotsman
  • No Self-Serve Ice Machine

• Serial number of Drive Thru Ice Machine

• Type of Ice Machine

  Remote

  Self Contained

• Condition of Drive Thru Ice Machine

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Additional Comments on Drive Thru Ice Machine

• Picture or Pictures of Drive Thru Ice Machine

  Media

Drive Thru Communication system

• Manufacturer of Drive Thru communication system

  HME

  3M

• Type of Drive Thru communication system. Digital or System 400

  Digital

  System 400

• Number of working headsets.

Smoothie Machine

• Manufacturer of Smoothie Machine?

  Sani-Serve

  Taylor

• Serial Number of Smoothie Machine.

• Condition of Smoothie Machine?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Picture of Smoothie Machine

  Media

• Additional Comments on Smoothie Machine:

Coffee / Tea Brewer

• Manufacturer of Coffee / Tea Brewer

  Bunn

  Wilber-Curtis

• How many Coffee / Tea Brewers are on site in use ?

• Condition of the Coffee / Tea Brewers

  Okay

  Minor repair/work needed

  Major repairs needed FY 14

  Major repairs needed FY 15

  Major repairs needed FY 16

• Picture or Pictures of Coffee / Tea Brewers

  Media

• Additional Comments on Coffee / Tea Brewers:

Microwaves

• Count of how many Microwaves are in use ?

• Picture or Pictures of microwaves.

  Media

POU Refrigerator

• Count of POU Refrigerators?

• Condition of POU Refrigerators?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Location of the POU Refrigerator needing replacement?

• Pictures of the POU Refrigerators.

  Media

• Additional Comments on POU Refrigerators:

POU Freezers

• Count of POU Freezers?

• Condition of POU Freezers?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Location of the POU Freezers needing replacement?

• Pictures of the POU Freezers.

  Media

• Additional Comments on POU Freezers:

Chef Stand 4 drawer unit

• Is there a Chef Stand 4 drawer at this store?

Information

• Is there a Chef Stand 4 Drawer at this store?

  Yes

  No

  N/A

• Picture or Pictures of the Chef Stand 4 drawer unit.

  Media

• Additional Comments on Chef Stand 4 Drawer unit.

Upright Refrigerators.

• Count of Upright Refrigerators?

• Condition of Upright Refrigerators?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Location of the Upright Refrigerators needing replacement?

• Pictures of the Upright Refrigerators.

  Media

• Additional Comments on Upright Refrigerators:

Upright Freezers

• Count of Upright Freezers?

• Condition of Upright Freezers?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Location of the Upright Freezers needing replacement?

• Pictures of the Upright Freezers.

  Media

• Additional Comments on Upright Freezers:

Dual - Temp Refrigerator / Freezer

• Count of Dual - Temp Refrigerator / Freezer ?

• Condition of Dual - Temp Refrigerator / Freezer?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Dual - Temp Refrigerator / Freezer Location of the needing replacement?

• Pictures of the Dual - Temp Refrigerator / Freezers.

  Media

• Additional Comments on Dual - Temp Refrigerator / Freezer :

Fryers

• Manufacturer of Fryers?

  Frymaster

  Pitco

• Count of Fryers?

  Select 1 2 3 4 5 6

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Serial number Fryer 1 ?

• Serial number Fryer 2 ?

• Serial number Fryer 3 ?

• Serial number Fryer 4 ?

• Serial number Fryer 5 ?

• Serial number Fryer 6 ?

• Condition of Fryers?

  Okay

  Minor repairs needed

  Replace FY14

  Replace FY15

  Replace FY16

• Picture or Pictures of Fryers?

  Media

• Additional Comments of Fryers?

Taco Stager

• Does the store have a Taco Stager

  Yes

  No

  N/A

• What size is the Taco Stager

• Picture of Taco Stager

  Media

• Additional Comments on Taco Stager?

Fry-bin

• Type of lamp on Fry-bin?

  Heat Lamp Bulb

  Cal-Rod-Heater

  Ceramic / Porcelain

• Is the Fry-bin Prototypical Mark 8 or 9 style unit?

  Yes

  No

  N/A

• Is the Fry-bin part of the cabinet it sits on or separate from the unit it sits on?

• Is the Fry-bin on legs or a curb?

  Sits on a Curb

  Sits on Legs

• Condition of the Fry-bin?

• Picture or Pictures of the Fry-bin.

  Media

• Additional comments on the Fry-bin:

Grill

• Manufacturer of the Grill?

  Select Lang Wolf US Range Taylor Clamshell (Gas / Electric) Taylor Clamshell (Electric) None

  • Lang
  • Wolf
  • US Range
  • Taylor Clamshell (Gas / Electric)
  • Taylor Clamshell (Electric)
  • None

• Is there a second grill in use at this store?

  Yes

  No

  N/A

• Manufacturer of the second Grill?

  Select Lang Wolf US Range Taylor Clamshell (Gas / Electric) Taylor Clamshell (Electric) None

  • Lang
  • Wolf
  • US Range
  • Taylor Clamshell (Gas / Electric)
  • Taylor Clamshell (Electric)
  • None

• What is the depth of the Hood? ( front to back )

• Does the grill sit on a curb?

  Yes

  No

  N/A

• What type of grill controller does the grill have?

  Lang

  NCC

  Taylor Clamshell Grill Controller

  Other

• Condition of the Grill?

  Okay

  Minor Repairs Needed

  Replace FY14

  Replace FY15

  Replace FY16

• Picture or Pictures of the Grill or Grills?

  Media

• Additional Comments on the Grill ?

Grill Timer

• Grill Timer ( What type of grill timer does the store have?)

  Fast 32

  NCC 24 Channel

  Prince Castle 893

  Taylor Clamshell Controller

• Add media

  Media

Fryer Timer

• Fryer Timer ( What type of fryer timer does the store have?)

  Fast 32

  NCC 24 Channel

  Prince Castle 893

  Taylor Clamshell Controller

• Add media

  Media

Toasters

Batch Toaster

• Batch Toaster Manufacturer?

  Prince Castle Dual Chamber

  Prince Castle Single Chamber

  Other

• Condition of batch toaster?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Picture of the Batch Toaster.

  Media

• Additional Comments on Batch Toaster:

Sourdough Toaster

• Sourdough Toaster Manufacturer?

  Prince Castle

  Prince Castle Dual Contact / Sourdough

• Condition of sourdough toaster?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Picture of the Sourdough Toaster.

  Media

• Additional Comments on Sourdough Toaster:

Sourdough Toaster

• Contact Toaster Manufacturer?

  Prince Castle

  Prince Castle Dual Contact / Sourdough

• Condition of contact toaster?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Picture of the Contact Toaster.

  Media

• Additional Comments on Contact Toaster:

Protein Holding Cabinet

• Protein Holding Cabinet Manufacturer?

  Prince Castle

  Duke

• Type of Protein Holding Cabinet?

  Verticle

  Horizontal

• Condition of Protein Holding Cabinet ?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Picture of the Protein Holding Cabinet.

  Media

• Additional Comments on the Protein Holding Cabinet:

Water Heater

• Water Heater Manufacturer?

  Select A.O Smith American Standard American RUUD Rheem Bradford White Noritz Raypac State Rennai

  • A.O Smith
  • American Standard
  • American
  • RUUD
  • Rheem
  • Bradford White
  • Noritz
  • Raypac
  • State
  • Rennai

• Water Heater Serial Number?

• Type of Water Heater?

  Tank

  Tankless

  Boiler

  Other

• Condition of the Water Heater ?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Picture of the Water Heater.

  Media

• Additional Comments on the Water Heater:

Coke

• Comments on Coke Bag-N-Box and rack.

• Picture or Pictures of Coke Bag-N-Box.

  Media

• Additional Comments on the Coke Bag-N-Box:

Water Filter System BOH

• Manufacturer of Water Filters?

  Selecto

  Everpure

• Date of last filter change if written on filter?

• Picture or Pictures of Water Filter system.

  Media

• Additional Comments on the Water Filters:

Dishwasher

• Dishwasher on site?

  Yes

  No

  N/A

• Picture or Pictures of Dishwasher

  Media

• Additional Comments on the Dishwasher:

3 Compartment Sink

• Picture or Pictures of 3 Compartment Sink.

  Media

• Additional Comments on 3 Compartment Sink.

Veggie Sink

• Picture of Veggie Sink.

  Media

• Additional Comments on Veggie Sink.

EMS system?

• Is there an EMS System at this store.

  Yes

  No

  N/A

• Location of the EMS System?

  Managers office

  Outside office

• Picture or Pictures of EMS System.

  Media

• Additional Comments on EMS System:

Kitchen Finishes

Kitchen Walls

• Condition of the Kitchen Walls?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Picture or Pictures of the Kitchen Walls.

  Media

• Additional Comments on the Kitchen Walls:

Kitchen Ceiling

• Condition of the Kitchen Ceiling?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Picture or Pictures of the Kitchen Ceiling.

  Media

• Additional Comments on the Kitchen Ceiling:

Kitchen Lighting

• What Type of fluorescent lighting is in the kitchen area?

  Fluorescent T8

  Fluorescent T12

• How many light fixtures are there in the kitchen, office, storage rooms.break rooms.

• Picture or Pictures of BOH lighting.

  Media

• Additional Comments on BOH Lighting.

Kitchen Floor

• Condition of the Kitchen Floors?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Picture or Pictures of the Kitchen Floors.

  Media

• Additional Comments on the Kitchen Floors:

Ice Machine - BOH

• Is there a BOH Kitchen Ice Machine?

Information on BOH Ice Machine.

• If yes, Manufacturer name of Kitchen Ice Machine?

  Select Manitowoc Hoshizaki Follett ice-O-Matic Scotsman No Self-Serve Ice Machine

  • Manitowoc
  • Hoshizaki
  • Follett
  • ice-O-Matic
  • Scotsman
  • No Self-Serve Ice Machine

• Type of Kitchen Ice Machine?

  Yes

  No

  N/A

• Condition of the Kitchen Ice Machine?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Picture or Pictures of the Kitchen Ice Machine.

  Media

• Additional Comments on the Kitchen Ice Machine:

RTI shortening tank information.

• Is this store on RTI shortening system?

  Yes interior tanks

  Yes exterior tanks

  No RTI at this site

• Picture of RTI system

  Media

Walk-In Cooler / Walk-In Freezer

Walk in Cooler Door

• Condition of Walk in Cooler Door and Frame

• Picture of Walk in Cooler Door and Frame

  Media

• Additional Comments on Walk in Cooler Door and Frame

Walk-In Cooler Evaporator Coil

• Walk-In Cooler Evaporator Coil Manufacturer?

  Select Larkin Heatcraft Bohn Russell Imperial Welbuilt Climate Control Trenton See other typed below

  • Larkin
  • Heatcraft
  • Bohn
  • Russell
  • Imperial
  • Welbuilt
  • Climate Control
  • Trenton
  • See other typed below

• Model of Walk-In Cooler Evaporator Coil?

• Serial Number of Walk-In Cooler Evaporator Coil?

• Condition of the Walk-In Cooler Evaporator Coil?

  Select Okay Minor repairs needed Replace FY14 Replace FY15 Replace FY16 None

  • Okay
  • Minor repairs needed
  • Replace FY14
  • Replace FY15
  • Replace FY16
  • None

• Picture or Pictures of the Walk-In Cooler Evaporator Coil.

  Media

• Additional Comments on the Walk-In Cooler Evaporator Coil:

Walk in Freezer Door and Fame.

• Condition of Walk in Freezer Door and Frame

• Picture of Walk in Freezer Door and Frame

  Media

• Additional Comments on Walk in Freezer Door and Frame:

Walk-In Freezer Evaporator Coil

• Walk-In Freezer Evaporator Coil Manufacturer?

  Select Larkin Heatcraft Bohn Russell Imperial Welbuilt Climate Control Trenton See other typed below

  • Larkin
  • Heatcraft
  • Bohn
  • Russell
  • Imperial
  • Welbuilt
  • Climate Control
  • Trenton
  • See other typed below

• Model of Walk-In Freezer Evaporator Coil?

• Serial Number of Walk-In Freezer Evaporator Coil?

• Picture or Pictures of the Walk-In Freezer Evaporator Coil.

  Media

• Additional Comments on the Walk-In Freezer Evaporator Coil:

• You are now heading to the roof.

Rooftop

• Is the roof hatch working correctly?

  Safe

  At Risk

  N/A

• Picture of Roof Hatch.

  Media

• Additional Comments on Roof hatch.

Roof Flat

• Type of Flat Roofing Material?

  Modified

  Single Ply PVC

  Rock /Asphalt built-up

• Condition of the Flat Roof?

  Okay

  Minor repairs needed

  Replace FY14

  Replace FY15

  Replace FY16

• Picture or Pictures of the Roof.

  Media

• Additional Comments on the Flat Roof:

Mansard Roof

Is there a Mansard or Sloped roof at this store?

• Type of Pitched Roofing Material?

  Select Wood Shingles Asphalt Shingles Metal Seam Spanish tile Cement tile Metal No Mansard Roof

  • Wood Shingles
  • Asphalt Shingles
  • Metal Seam
  • Spanish tile
  • Cement tile
  • Metal
  • No Mansard Roof

• Condition of the Pitched Roof?

  Okay

  Minor repairs needed

  Replace FY14

  Replace FY15

  Replace FY16

• Picture or Pictures of the Mansard Roof.

  Media

• Additional Comments on the Pitched Roof:

HVAC UNITS

Kitchen HVAC Unit

• Manufacturer of Kitchen HVAC Unit?

  Select York Carrier Aaon Trane American Standard Lennox See other listed below

  • York
  • Carrier
  • Aaon
  • Trane
  • American Standard
  • Lennox
  • See other listed below

• Manufacturer of Kitchen HVAC Unit if not listed above?

• Model of Kitchen HVAC Unit?

• Serial Number of Kitchen HVAC Unit?

• Picture of the Manufacturer name plate.

  Media

• Condition of Kitchen HVAC unit?

  Okay

  Minor repairs needed

  Replace FY14

  Replace FY15

  Replace FY16

• Picture or Pictures of the Kitchen HVAC Unit.

  Media

• Additional Comments on the Kitchen HVAC unit?

Dining Room HVAC Unit

• Manufacturer of Dining Room HVAC Unit?

  Select York Carrier Aaon Trane American Standard Lennox See other listed below

  • York
  • Carrier
  • Aaon
  • Trane
  • American Standard
  • Lennox
  • See other listed below

• Manufacturer of Dining Room HVAC Unit if not listed above?

• Model of Dining Room HVAC Unit?

• Serial Number of Dining Room HVAC Unit?

• Picture of the Manufacturer name plate on the Dining Room HVAC Unit.

  Media

• Condition of Kitchen HVAC unit?

  Okay

  Minor repairs needed

  Replace FY14

  Replace FY15

  Replace FY16

• Picture or Pictures of the Dining Room HVAC Unit.

  Media

• Additional Comments on the Dining Room HVAC unit?

Other HVAC Unit # 1

• Is there an Other HVAC Unit # 1?

Information on Other HVAC #1?

• Manufacturer of Other HVAC Unit # 1?

  Select York Carrier Aaon Trane American Standard Lennox See other listed below

  • York
  • Carrier
  • Aaon
  • Trane
  • American Standard
  • Lennox
  • See other listed below

• Manufacturer of Other HVAC Unit # 1 if not listed above?

• Model of Other HVAC Unit # 1?

• Serial Number of Other HVAC Unit # 1?

• Picture of the Manufacturer name plate on the Other HVAC Unit # 1.

  Media

• Condition of Other HVAC Unit # 1?

  Okay

  Minor repairs needed

  Replace FY14

  Replace FY15

  Replace FY16

• Picture or Pictures of the Other HVAC Unit # 1

  Media

• Additional Comments on the Other HVAC Unit # 1:

Other HVAC Unit # 2

• Is there an Other HVAC Unit # 2?

Information on Other HVAC #2?

• Manufacturer of Other HVAC Unit # 2?

  Select York Carrier Aaon Trane American Standard Lennox See other listed below

  • York
  • Carrier
  • Aaon
  • Trane
  • American Standard
  • Lennox
  • See other listed below

• Manufacturer of Other HVAC Unit # 2 if not listed above?

• Model of Other HVAC Unit # 2?

• Serial Number of Other HVAC Unit # 2?

• Picture of the Manufacturer name plate on the Other HVAC Unit # 2

  Media

• Condition of Other HVAC Unit # 2?

  Okay

  Minor repairs needed

  Replace FY14

  Replace FY15

  Replace FY16

• Picture or Pictures of the Other HVAC Unit # 2

  Media

• Additional Comments on the Other HVAC Unit # 2:

Exhaust Fans

• Manufacturer of the Exhaust Fans?

  Select Supreme Central Greenheck Tri-Pack See other listed below

  • Supreme
  • Central
  • Greenheck
  • Tri-Pack
  • See other listed below

• How many Exhaust Fans are there?

• Condition of the Exhaust Fans?

  Okay

  Minor repairs needed

  Replace FY14

  Replace FY15

  Replace FY16

• Pictures of Exhaust Fans.

  Media

• Additional Comments on Exhaust Fans:

MUA Units

• Is there a MUA at this site?

Provide information on MUA?

• How many MUA Units are there?

• Manufacturer of MUA Units?

  Select Supreme Greenheck Captive Aire Master Cool Essick Air Systems Phoenix See other listed below No MUA at this site kitchen has an HVAC unit for MUA.

  • Supreme
  • Greenheck
  • Captive Aire
  • Master Cool
  • Essick Air Systems
  • Phoenix
  • See other listed below
  • No MUA at this site kitchen has an HVAC unit for MUA.

• Condition of the Make up air units.

  Okay

  Minor repairs needed

  Replace FY14

  Replace FY15

  Replace FY16

• Picture or pictures of Make up Air units.

  Media

• Additional Comments on MUA Units.

Walk in Cooler / Walk in Freezer condensing unit information.

Walk in Cooler condensing unit information.

• Walk in Cooler condensing unit manufacturer?

  Select Larkin Heatcraft Bohn Russell Imperial Welbuilt Climate Control Trenton See other typed below

  • Larkin
  • Heatcraft
  • Bohn
  • Russell
  • Imperial
  • Welbuilt
  • Climate Control
  • Trenton
  • See other typed below

• Walk in Cooler condenser model number?

• Walk in Cooler condensing unit serial number?

• Condition of the Walk in Cooler condensing unit?

  Okay

  Minor repairs needed

  Replace FY14

  Replace FY15

  Replace FY16

• Picture or pictures of Walk in Cooler Condensing unit.

  Media

• Additional Comments on Walk in Cooler condensing unit?

Walk in Freezer condensing unit information.

• Walk in Cooler condensing unit manufacturer?

  Select Larkin Heatcraft Bohn Russell Imperial Welbuilt Climate Control Trenton See other typed below

  • Larkin
  • Heatcraft
  • Bohn
  • Russell
  • Imperial
  • Welbuilt
  • Climate Control
  • Trenton
  • See other typed below

• Walk in Freezer condenser model number?

• Walk in Freezer condensing unit serial number?

• Condition of the Walk in Freezer condensing unit?

  Okay

  Minor repairs needed

  Replace FY14

  Replace FY15

  Replace FY16

• Picture or pictures of Walk in Freezer Condensing unit.

  Media

• Additional Comments on Walk in Freezer condensing unit?

Additional Comments on store or issues to research.

• Picture of issues not noted in any other section.

  Media