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1. Store Visited.

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2. Date and time of visit.

Date
Time

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3. Were you properly greeted when you entered the store?

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4. Were you assisted in the aisle while shopping?

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5. How would you rate the appearance of our store?

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6. Please rate each department based on the quality of items and the variety of selections.

  Very Good Good Fair Poor Very Poor
Meat
Produce
Grocery
Freeze & Chill

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7. Do you feel your importance as a customer was truly appreciated?

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8. How would you rate our cashier's customer service?

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9. Was the Store Manager or Assistant Store Manager present in the front during your checkout?

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10. Please rate your shopping experience.

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11. What would you like to see improved in our stores to better serve you?

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12. Are there any noteworthy employees? Please explain. 

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13. Contact information (Optional)

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