RESTAURANT QUESTIONNAIRE
BUSINESS OPERATIONS
1. 2. 3. 4. 5. 6. 7. 8. 9. Restaurant Name __________________________________________________________________________ Is restaurant part of Franchise Operation? [ ] Yes [ ] No If yes, where is parent company?______________________________________________________________ Is the restaurant near any piers, wharves, or docks? [ ] Yes [ ] No If the restaurant is in a multi-story building, on what floor is it?________ What are days and hours of operation? _________________________________________________________ Type of food served (fast food, deli/take-out, family style or formal dining): ___________________________ Any off-site catering? [ ] Yes [ ] No If Yes, sales______________________________________________ Live entertainment? [ ] Yes [ ] No Dance Floor? [ ] Yes [ ] No If yes, describe fully. Include type of entertainment, average number of people in attendance, and frequency per month. _______________________________________________________________________ Any tableside cooking? [ ] Yes [ ] No
7. 1. 2. 3. 4. 5. 6. 7. 8. 7. 8. 9. 10. 11. 12. 13. 1. 2. 3.
COOKING SAFEGUARDS
Automatic fire extinguishing system protecting all cooking surfaces including deep fat fryers? [ ] Yes [ ] No Name of system manufacturer (Ansul, Kidde, other). __________________________________________ Are hoods and filters free of built-up grease? [ ] Yes [ ] No How often are hoods and filters cleaned?_______ Name of Company Contracted for Cleaning?____________ Is there a Janitorial company contracted? [ ] Yes [ ] No If so, do they have a formal safety program? [ ] Yes [ ] No How often is outside exhaust cleaned? __________________________________________________________ Commercial firm to service extinguishing system? [ ] Yes [ ] No, Semi-Annual Basis? [ ] Yes [ ] No Name of Firm:______________________________ Date last serviced: _____________________________ Fuel Shut-off valve accessible? [ ] Yes [ ] No Manual release properly located? [ ] Yes [ ] No High temperature limit controls on deep fat fryers? [ ] Yes [ ] No Is trash removed promptly from kitchen area? [ ] Yes [ ] No Employees instructed in proper operation of portable fire extinguishers? [ ] Yes [ ] No Easy Access to portable fire extinguishers? [ ] Yes [ ] No Date last serviced: ___________________ At least one 40 B.C. Extinguisher in cooking area? [ ] Yes [ ] No
GENERAL SAFEGUARDS
Adequate number of exits, easily accessible? [ ] Yes [ ] No Restrooms clean and well maintained? [ ] Yes [ ] No Describe pest extermination procedure and pesticide use?__________________________________________ _________________________________________________________________________________________ 4. Any violations noted by Board of Health? Time frame: __________________________________________ 5. Accurate record of all outside food suppliers? ____________________________________________________ 6. Control and record of shelf life of products? _____________________________________________________
LIQUOR EXPOSURES (If Applicable)
Is there a separate bar or lounge? [ ] Yes [ ] No Has the liquor license ever been revoked or suspended? [ ] Yes [ ] No Is there a program to prevent the serving of intoxicating beverages to minors or to people who become intoxicated? [ ] Yes [ ] No 4. Does the applicant have any special program with respect to reducing loss potential from drivers who have been drinking (such as offering free non-alcoholic drinks to drivers, free rides home)? [ ] Yes [ ] No If yes, describe: ___________________________________________________________________________ ____________________________________________________________________________________________ 1. 2. 3.
**Financial Statements Necessary for Binding**