Retail Self-Checkout Weight Verification Log Form
Use this form to log and resolve self-checkout weight discrepancies in the retail store.
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Self-Checkout Terminal ID or Location
*
Item Name or Description
*
Expected Weight (grams)
*
Observed Weight (grams)
*
Description of Discrepancy
*
Staff Member Reviewing (Initials or Employee ID)
*
Resolution Actions Taken
*
Resolution Status
*
Resolved - Customer Proceeded
Resolved - Item Removed
Escalated to Supervisor
Other
Submit Log
Should be Empty: