Title Page

  • Store #

  • Location
  • Conducted on

  • Personnel on duty

  • Prepared by

Outside Areas

  • Are pump surfaces clean and polished?

  • Register does not show paper jams nor paper out?

  • All pumps working? If not, is pump bagged/out of order, email report been sent, and note in communication log?

  • Squeegees in place, water full, fresh; plastic gloves/towels/sanitizer stocked?

  • Parking lot/landscaped areas trash free, no spills, oil and fuel residue?

  • Dumpster area clean, trash picked up, odor-free, doors closed, in good repair?

  • Check for an air chuck on water/air machine AND claw on vacuum?

  • Is air/vacuum/mat washer operational? Test all.

  • Is the car wash working? (Watch a vehicle go through and inspect.)

  • Are all car wash chemicals stocked?

  • Reader board being fully used with no misspellings and proper message displayed?

  • Outside rug, trash cans clean and not overflowing?

  • Front door clean without smudges?

  • Windows and ledges clean?

Inside Areas

  • Are the floors clean?

  • Are the mats clean?

  • Gondola shelves well stocked (with 3 or less out of stocks), priced correctly, fronted, dust free?

  • Are drink dispensers and nozzle/lid dispensers clean?

  • Are counter tops and fronts of cabinets clean and free of trash and spills?

  • Is fountain area fully stocked and clean?

  • Is coffee area fully stocked and clean?

  • Are the coffee products fresh/available/clean?

  • Is at least one flavor of coffee available and fresh?

  • Are cooler doors clean?

  • Is cooler stocked well with 3 or less out of stocks/empty rows?

  • Are the following "never outs" in stock?

  • Milk

  • Ozarka/NPL 20 oz and 1 liters

  • Coke

  • Diet Coke

  • Dr Pepper

  • Diet Dr Pepper

  • Mountain Dew

  • Red Bull

  • Monster

  • Gatorade - top 3

  • Bud Ice - 24

  • Nat Light - 24

  • Keystone - 24

  • Corona - 6 pack

  • Bud - 6 pack & 12 pack

  • Coors Light - 6 pack & 12 pack

  • Are scratch offs fully stocked?

  • Are tobacco merchandiser full and the following "never outs" in stock?

  • Marlboro Red

  • Marlboro Gold

  • Marlboro Special Blend

  • Copenhagen Regular

  • Copenhagen Long Cut

  • Copenhagen Wintergreen

  • Grizzly Long Cut Wintergreen

  • Are all employee sodas and food products properly stored?

  • Is CO2 level above 25%

  • Is enough ice bagged for the business?

  • Are ice machines free of slime and mold?

Restroom - Mens

  • Toilet bowl and/or urinal are sparkling clean.

  • Lid or underneath the toilet lid is clean.

  • Sink is clean.

  • Floor is clean, bug free and litter free.

  • Paper towels are available.

  • Toilet paper is available.

  • Diaper changer liners are available.

  • Soap (and sanitizer, if applicable) is available.

  • Mirror is clean.

  • There is a pleasant odor in the restroom.

  • Walls and/or stall dividers are clean.

  • Everything is operational (toilets, sinks, soap dispensers, dryer).

  • Trash isn't full and container is clean.

  • No lights are out or bugs in lenses.

  • Vents are not dusty or dirty.

  • Check restroom supplies for outages

  • Is Royal Restroom checklist being used?

Restroom - Womens

  • Toilet bowls are sparkling clean.

  • The lid and underneath the toilet lid is clean.

  • Sink is clean.

  • Floor is clean, bug free, litter free.

  • Paper towels are available.

  • Toilet paper is available.

  • Diaper changer liners are available.

  • Soap, (and sanitizer, if applicable) is available.

  • Mirror is clean.

  • There is a pleasant odor in the restroom.

  • Walls and/or stalls dividers are clean.

  • Everything is operational (toilets, sinks, soap dispensers, dryer).

  • Trash isn't full and container is clean.

  • No lights are out or bugs in lenses.

  • Vents are not dusty or dirty.

  • Check restroom supplies for outages

  • Is Royal Restroom checklist being used?

Deli/Roller Grill Area

  • Are all hand wash sinks accessible and stocked?

  • Are all food products labeled and stored correctly? Creamer, Bag-in-the-Box, Nacho Cheese dated (and not expired)?

  • Are microwaves/ovens/holding units lighted, in good repair and clean?

  • (Where applicable) Are tables/chairs/dining floor clean?

  • Is there an appropriate amount of hot dogs on the grill that look fresh and buns available?

  • Do the rollers, sneeze guards, tongs, and tray on the grill look clean?

  • Is there at least one bucket with fresh sanitizer and a towel available?

  • Is air cooler stocked, with no out of dates and everything priced?

Administrative - Safety and Compliance & Customer Service

  • Is the video viewable and manager viewing & logging 15 min/day?

  • Is the yellow Emergency/Safety book by the register?

  • Is environmental checklist current and up front in blue folder?

  • Are all surveillance cameras working and displaying clearly?

  • Is video/register overlay working and displaying properly?

  • Is communication log posted and current?

  • Is the most recent check stuffer posted?

  • Is the most recent Star Savers' transactions info posted?

  • Are all cigarette counts current and within tolerance?

  • Do employees suggestive sell and promote the Star Savers program?

  • Employees fast, friendly, greeting customers, & thanking customers?

  • Are all employees in full uniform?

  • Do employees use proper cash handling procedures?

  • Do employees card customers buying age-restricted items who appear <30?

  • Is "We Card" calendar current and visible to employee?

  • Are walkarounds complete and current?

  • Using manager video log, view a segment that manager has watched to give additional employee feedback.

  • Are deficiencies in employee training log being addressed?

  • Is first aid kit adequately stocked and accessible?

  • Is Manager verifying employee clock in/out time daily?

  • Are cashier averages up to date and posted?

Signature

  • I hereby certify that the above form is true and accurate to the best of my knowledge.

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.