Fountain Beverage Equipment Survey
Please complete this survey to provide information about the fountain beverage equipment at your location.
Location Name or ID
*
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Fountain Beverage Equipment
*
Please Select
Countertop Dispenser
Freestanding Dispenser
Built-in Unit
Other
Overall Equipment Condition
*
Excellent
Good
Fair
Poor
Has the equipment been cleaned/maintained in the past week?
*
Yes
No
Not Sure
Are all beverage supplies (syrup, CO2, cups, etc.) available and stocked?
*
Yes, fully stocked
Some items low/out of stock
No, supplies missing
Additional Comments or Observations
Submit Survey
Should be Empty: