SAMPLE SHOPPING QUESTIONNAIRE
NOTE: Each time you go on a Field Auditor Trip, you will use a form designed by the store or business establishment. This is only a sample. 
BUSINESS (Store) NAME: ________________________________________________
ADDRESS:_________________________________________________
Field Auditor NAME:__________________________________________
DATE AND TIME OF SHOPPING EXPERIENCE:_____________________________ 
YES NO N/A
Was store clean and neat?
Was lobby/waiting area clean?
Was your presence acknowledged within a short time of arrival?
Were you greeted in a friendly manner?
Were employees dressed professionally?
Did they offer to assist you with problems?
Were they courteous?
Did they know their products well?
Were the dressing rooms clean?
Did they thank you for shopping with us?
In the space provided below, please give a summary of your shopping experience.
__________________________________________________________________
__________________________________________________________________
How do you rate this establishment?
____________Excellent
____________ Good
____________ Fair
____________ Poor
Based on your experience, would you shop at this location again in the future?_________
__________________________________ ______________________________
Your signature _____________________________________ 

Date Submitted _________________