Information

  • Store Number

  • Location

  • Conducted on

  • Prepared by

Summary Page

Location Summary

  • Store Number

  • City

  • Facility Photo

  • Store Manager

  • Store Manager Photo

  • District Manager

Site Visited On

  • Time in:

  • Time Out:

Rating Scale

  • Rating Scale:
    Excellent: 95% or Greater
    Satisfactory: 90% to 94%
    Marginal: 80% to 89%
    Unsatisfactory: 79% or Below

Overall Assessment Rating

  • Overall Assessment Rating

    Include Exterior Facility, Interior Facility, and Food Service Safety and Execution scores to calculate Overall Assessment Rating.
    Manually calculate: (Exterior + Interior + Food) / 3 = Overall Assessment Rating

  • Overall Assessment Rating

  • Overall Assessment Score

Overall Assessment Rated Categories

  • Facility & Equipment - Exterior Rating

  • Facility & Equipment - Exterior Score

  • Facility & Equipment - Interior Assessment

  • Facility & Equipment - Interior Score

  • Food Service Safety and Execution Assessment

  • Food Service Safety and Execution Score

Stand Alone Rated Categories

  • Core Programs & Vendors Assessment

  • Core Programs & Vendors Score

  • Training & Technology Assessment

  • Training & Technology Score

Gallons

  • Sales Trend Through

  • MTD:

  • YTD:

  • Goal:

Customer Count

  • Customer Count MTD

  • Customer Count YTD

Inside Sales

  • MTD w/o Cigs:

  • YTD w/o Cigs:

  • Goal w/o Cigs:

  • MTD w/ Cigs:

  • YTD w/ Cigs:

  • MTD & YTD Sales Discussion:

General Comments Noted During Visit

  • Strengths:

  • Opportunities:

Facility & Equipment - Exterior

Weighted Score Legend

  • Scoring:
    Meets Standards select Yes
    Does not Meet Standards select No
    If a Recurrence select Repeat

    Items are weighted:
    ⚪=1
    🔵=4
    A Yes or No will apply the appropriate value to the overall score.

Trademark / Reader Board Sign

  • ⚪Clean

  • 🔵Well Lit

  • ⚪Reader Board / DMC in Good Condition

  • 🔵Reader Board / DMC Messaging Current

Lot / Landscaping

  • 🔵Free of Trash, Trash Lines and Debri

  • 🔵Snow Cleared / Lawn Maintained / Weeds Controlled

  • ⚪Lot Well Striped

  • ⚪Tank Covers in Good Conditions

  • ⚪Tank ID Collars in Place

  • 🔵Monthly Tank Inspections Completed / Class C Operator on Duty

  • ⚪Trash Dumpster Areas Well Maintained

Canopy / Dispenser Island

  • 🔵Area Free of Trash, Trash Lines, Stains and Debris. In winter, free of snow and ice.

  • 🔵Pumps Clean and in Good Condition

  • 🔵All Pumps in Working Order

  • ⚪Hoses Proper Length / Not Dragging on the Ground

  • 🔵Decals in Good Condition

  • ⚪Nozzle Talkers Current and Fresh with Nozzle Covers in Place

  • 🔵Current Topper / Dispenser Signs

  • ⚪Requires Signs Posted (No Smoking, etc.)

  • 🔵Pay at the Pump Working

  • ⚪Island Forms and Canopy Poles Painted

  • 🔵Canopy Lighting Working, No More than 2 Lights Out

  • 🔵Washer Buckets Clean and Filled

  • 🔵Number & Condition of Squeegees OK

  • 🔵Towels Filled / Available

  • 🔵Trash Cans Emptied in a Timely Manner

  • ⚪Trash Cans Clean

Building

  • 🔵Car Wash Working

  • 🔵Car Wash Clean, Including Walls, Doors, Floor, Pit, and Equipment

  • ⚪Car Wash Entrance and Exit Clean

  • ⚪Vacuum Area Clean and Trash Emptied as Needed

  • 🔵Air Hose Available / Working (Spare Hose Available November thru April)

  • ⚪Ice Chest Clean / Good Condition

  • ⚪Propane Cage Clean / Signed

  • 🔵Outside Displays Clean, Seasonal Fresh, Organized, Stocked, and Signed

  • 🔵Windows Clean and Proper Promo Signage in Place

  • ⚪Door Clean

  • ⚪Door Decals Properly Placed

  • ⚪No Foreign / Cluttered Signage

  • ⚪Push Plates in Good Condition

  • ⚪Doors Working Properly

  • 🔵Building Lighting Working

  • 🔵Snow Cleared / Sidewalks Maintained (No Stains)

  • ⚪General Conditions of Drive and Parking Lot Cement and Pavement

Safety Concerns Observed

  • Safety concerns observed of the exterior Facility & Equipment.

Facility & Equipment - Interior

  • Scoring:
    Meets Standards select Yes
    Does not Meet Standards select No
    If a Recurrence select Repeat

    Items are weighted:
    ⚪=1
    🔵=4
    A Yes or No will apply the appropriate value to the overall score.

General Sales Floor

  • 🔵Merchandise Signed, Faced, and Clean

  • 🔵Product Dating / Rotation Appropriate

  • ⚪Floor / Rugs Clean

  • 🔵Feature End Cap Set Correctly

  • 🔵Signage in Place (Review Smart Value Checklist)

  • ⚪Floor Shippers in Position and Signed

  • 🔵Plan-o-grams Current

  • 🔵Shelf Tags Current

  • ⚪New Item Arrow Program in Place / 2 Months

  • ⚪Grid Work Up / Correct

  • 🔵Pop Ceiling / Shelf Signs Correct

  • 🔵Overall Stock Levels Appropriate

  • ⚪Fruit Available, Fresh, and Signed

  • ⚪ATM & Phone Clean / Working

Coolers / Freezers

  • 🔵Interior Clean / Organized / Well Lit

  • 🔵Exterior Clean

  • 🔵Adequate Lighting (Exterior)

  • 🔵Profiled Correctly

  • 🔵Proper Signage in Place

  • 🔵Stock Levels Appropriate (6 Empty Glides In Cooler)

  • 🔵Product Dating / Rotation Appropriate

Checkout Appearance and Security

  • ⚪Room for Customer Merchandise

  • ⚪Merchandised To Plan-o-gram Under Counter

  • 🔵Merchandised To Plan-o-gram on Counter

  • ⚪Proper Tobacco Signage in Place

  • 🔵Security Area Neat and Clean

  • 🔵Age Restricted Signs Posted

  • ⚪Cash & Checks Secure / Drops Timely

Customer Service Assessment

  • 🔵Appropriate Uniform

  • 🔵Appropriate Greeting

  • 🔵Employees Practice Enhanced Customer Care

  • 🔵Sincere Thank You

  • 🔵Good Customer Flow

  • 🔵Age Restricted Sales Policy Followed Within Last 60 Days

  • ⚪Intercom Used Effectively

Miscellaneous

  • ⚪Current Employment Postings

  • ⚪Emergency Phone Numbers Posted

  • ⚪Cameras Operating

  • 🔵Interior Lighting Appropriate

  • ⚪Ceiling Tiles in Good Condition

  • ⚪Walls in Good Condition

  • ⚪Floor Tiles in Good Condition

  • ⚪Emergency Exit Clear

  • ⚪Back Room Doors Closed

Safety Concerns

  • Safety concerns observed of the Interior Facility & Equipment.

Food Service Safety and Execution

  • Scoring:
    Meets Standards select Yes
    Does not Meet Standards select No
    If a Recurrence select Repeat

    Items are weighted:
    ⚪=1
    🔵=4
    ⚫=6
    🔴=Critical Item up to -12
    A Yes or No will apply the appropriate value to the overall score.

General Conditions

  • 🔵Food Areas Clean?<br>(Floors, counters, vents, etc.)

  • 🔵Sanitize Solution, available and in use? Tested 200 ppm?

Hot Food Program

  • 🔴Appropriate Selection for time of the day?

  • 🔵HATCO Clean and Programmed Correctly, Proper Signage?

  • 🔴Product timed properly? No expired product in the HATCO?

  • ⚪Ovens / Customer Microwaves clean?

  • 🔵WSSR reporting reviewed weekly, current Power Hours posted

  • 🔵Checkout prep area is clean and organized

  • 🔵Employees wash hands and handle food properly (wear gloves)?

Sandwich Case & Condiment Bar

  • 🔴Appropriate product selection in case?

  • How many missing?

  • 🔵Sandwich case planogrammed correctly with proper signage?

  • 🔴All items dated correctly and nothing outdated?

  • ⚪Sandwich case clean and faced?

  • ⚫Condiment station / cooler clean ? Condiment items properly dated?

Roller Grill

  • 🔴Product available for required program hours?

  • 🔴Product at proper temperature?

  • 🔵Station is clean with tongs available?

  • ⚪Product is properly timed, buns dated?

  • ⚪Proper signage in place?

Coffee & Cappuccino Program

  • 🔴Appropriate level of product available for time of day?

  • 🔵Equipment clean (tops, baskets, spray heads, interior)?

  • ⚪Coffee grounds emptied in a timely manner?

  • ⚪Coffee timers clean and properly used?

  • ⚪Coffee syrup bottles and pumps are filled and cleaned?

  • ⚪Coffee condiment station is clean and supplies in stock?

Creamiser Station

  • 🔵Half & Half dated 7 days, other bags 14 days (Skim milk dated same as carton used)? Check for cleanliness on outside, top and inside unit. No mold present, nipples cut to proper length, temperature at 33 to 41 degrees.

Fountain Program

  • 🔵No mold buildup on fountain heads, ice bin on fountain machine and ice chute clean, and all BIBs are within proper selling dates.

Bakery Program

  • 🔴Appropriate product selection for time of the day? (Never out of cookies & muffins)

  • 🔵Bakery case(s) clean and faced / product rotated?

  • ⚪Case is set to planogram and proper tags in place?

Product Rotation (Dating & Stales)

  • 🔵Food Program (Back stock properly dated / rotated)?

  • 🔵Proper Cooler Rotation (Milk, Juice, Meats & Cheeses, etc.)?

  • 🔵HP Thaw & Serve Program executed correctly?

Back Room

  • 🔵Ice maker bin & bucket clean? Scoop properly stored?

  • ⚪Triple sinks clean and properly labeled?

  • ⚪No fresh food in sinks, no chemicals stored above sinks?

  • ⚪Water filters are clean and properly dated?

  • ⚪Sink room overall is up to Holiday standards?

Cooler

  • 🔵Proper temperature and temp control procedure in place?

  • ⚪Interior clean and organized, no boxes stored on floor?

  • ⚪Cooling fans clean and lights covered?

Restrooms

  • ⚫Clean?

  • 🔵In good repair / working?

  • ⚪Stocked?

Comments

  • Enter Additional Comments Here

Core Programs & Key Vendors

  • Scoring:
    Meets Standards select Yes
    Does not Meet Standards select No
    If a Recurrence select Repeat

    Items are weighted:
    ⚪=1
    🔵=4
    A Yes or No will apply the appropriate value to the overall score.

Holiday Proprietary Programs

  • 🔵Drink Bar

  • 🔵Commissary Program (GTC)

  • 🔵Sandwich Program (UM)

  • ⚪Sampling

  • 🔵Jerky Program

  • 🔵Candy / Snacks Program

  • 🔵Water / Juice / Energy Drink Program

  • 🔵Bakeshop Program (GTC)

  • 🔵Bakery Program (UM)

  • 🔵HP Milk Program

  • 🔵HP Gift Card Program

  • 🔵Credit Card / Fleet Card

  • 🔵Marketing Plan

  • 🔵Automotive Program

Key Vendor Programs

  • 🔵Pepsi

  • 🔵Coke

  • 🔵Frozen Pizza Program

  • 🔵Ice Cream Program

  • ⚪Klements

  • ⚪World Kitchens

  • ⚪Dairy Program

  • 🔵Frito Lay

  • ⚪Old Dutch

  • ⚪Prepaid Card Program

  • 🔵McLane

  • ⚪Deli Express or Kitchen Fresh (UM)

  • ⚪Solaray

  • ⚪CVP (HBC)

  • ⚪Roller Grill

Training & Technology

  • Scoring:
    Meets Standards select Yes
    Does not Meet Standards select No
    If a Recurrence select Repeat

    Items are weighted:
    ⚪=1
    🔵=4
    A Yes or No will apply the appropriate value to the overall score.

Training / Employee Development

  • 🔵Manager through Holiday Training Program

  • 🔵All employees in the process or current on all CBT modules

  • 🔵ServeSafe Training Program

  • List One Name

Online Materials

  • ⚪Manager / Assistant Manager training materials AVAILABLE and UTILIZED

  • ⚪Operations Manual

  • ⚪Food Service Cookbook

Technology

  • ⚪Current POS and Back Office Systems

  • ⚪High Speed Communication in place

  • ⚪Backup Credit Device

  • ⚪Store Communications Network (Intranet)

  • ⚪StoreFront

Photos

  • Add additional photos?

  • Enter additional photos.

  • General Photos
  • Add media

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.