GEM Site Evaluation Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Contact Name?

• Contact Email?

• Business Phone #?

• Cell Phone #

Hours of operation. ( If slider not selected the location is closed for the day.)

• Monday

  Off

  On

• Open

  Date

• Close

  Date

• Tuesday

  Off

  On

• Open

  Date

• Close

  Date

• Wednesday

  Off

  On

• Open

  Date

• Close

  Date

• Thursday

  Off

  On

• Open

  Date

• Close

  Date

• Friday

  Off

  On

• Open

  Date

• Close

  Date

• Saturday

  Off

  On

• Open

  Date

• Close

  Date

• Sunday

  Off

  On

• Open

  Date

• Close

  Date

Site survey information.

• Rough floor plan of location showing game placement, placement for Scientific games equipment, kiosk or cash dispenser. Also show the bar, and any other objects, ie: pool tables, dart boards in the building.

  Drawing

• Area for Game Placement and Scientific Games equipment.

  Media

• Number of terminals?

• Notes:

• Area for Kiosk or Cash Dispenser

  Media

• Distance from Scientific Games equipment? (FT)

• Notes

Building Pictures

• Location inside pictures. All views.

  Media

• Location outside pictures. All views.

  Media

Security and parking.

• Does Location have alarm system?

  Yes

  No

  N/A

• Does location have camera system inside?

  Yes

  No

  N/A

• Does location have parking?

  Yes

  No

  N/A

• Approximate number of spaces if parking available.

• Is parking well lit?

  Yes

  No

  N/A

• Does parking area have camera system?

  Yes

  No

  N/A

Power related.

• Power outlets available for all equipment?

  Yes

  No

  N/A

• If outlets available. Checked for proper operation?

  Safe

  At Risk

  N/A

• Sketch if needed for further explanation.

  Drawing

• Pictures if needed for further explanation.

  Media

Site visitation.

• Site survey head count done?

  Yes

  No

  N/A

• Date and time of head count performed?

  Date

• Number of customers counted.

• Cell signal good or bad?

• Does This Location <br>have an ATM?<br><br><br><br>

  Yes

  No

  N/A

• Does This Location have Lottery?

  Yes

  No

  N/A

Other

• Age Restrictions, 21 or older?

  Yes

  No

  N/A

• Date of previous site survey if known

  Yes

  No

  N/A

• Additional notes:

GEM Rep Signature

• Survey conducted by:

  Sign