Retail Shelf Protection Survey Form
Complete this survey to assess shelf protection and loss prevention conditions in your retail location.
Store/Location Identification
*
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
First Name
Last Name
Department/Aisle
*
Please Select
Produce
Dairy
Bakery
Grocery
Health & Beauty
Household
Other
Product Category Inspected
*
Please Select
Beverages
Snacks
Cleaning Supplies
Personal Care
Frozen Foods
Other
Shelf Protection Status
*
Good
Fair
Poor
Observed Issue Types (select all that apply)
Broken shelf
Missing security devices
Obstructed view
Product overstock
Tampered packaging
Other
Severity of the Issue
*
Low
1
2
3
4
High
5
1 is Low, 5 is High
Was evidence collected?
*
Yes
No
Follow-up Action Needed
*
No action needed
Immediate fix required
Monitor for future
Other
Additional Notes
Submit Survey
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