Store Cleanliness Shop Feedback Form
Share your feedback to help us maintain excellent cleanliness and housekeeping standards in our store.
Store Location
*
Date of Visit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Overall Cleanliness Rating
*
1
2
3
4
5
How clean were the store floors?
*
Very Clean
Clean
Average
Needs Improvement
Poor
How would you rate the cleanliness of restrooms?
Very Clean
Clean
Average
Needs Improvement
Poor
How tidy were the product displays and shelves?
Very Tidy
Tidy
Average
Needs Improvement
Poor
Did you notice any unpleasant odors in the store?
No, none at all
Mild odors
Strong odors
Were trash bins emptied and clean?
Yes, all were clean
Some were not clean
No, most were not clean
Additional Comments or Suggestions
Would you like us to follow up with you?
No
Yes (please provide your email below)
Your Email (optional)
example@example.com
Submit Feedback
Should be Empty: