This is to be used as an example only.  It is completely fiction.
J'S BAR & GRILL
14471 Sprague Street
Beverly Hills, CA  90210
Shopper Name: Bryan Grafft Date: 7/10/01
Shopper ID: 950723 Time Entered: 6:53 PM
Time Exited: 7:59 PM
Transaction # (from receipt): 035478 Amount of Tip left: $7.00
Total Amount of Check: $45.38 Misc. Expenses (parking, etc.)  $                -  
                               
PHONE CALL Name: Carrie (if none given, note male/female)
 1. Time call was made: 6:15 PM
 2. Number of rings before phone was answered: 2
 3. Did the person identify the location and state their name? YES X NO  
 4. Were they polite and easily understood? YES X NO  
 5. Based on the phone conversation, would you dine at this location? YES X NO  
COMMENTS: (please explain all "NO" answers)
Carrie was very friendly and outgoing.  She gave clear and accurate directions to the location.  When asked, she was able to give me the hours of operation.  Carrie cheerfully invited me to the restaurant.  Our phone conversation would have motivated me to dine there, had I not been sure of which restaurant to dine at.  My overall first impression was favorable at this point.
HOST/HOSTESS Name/Description: Aaron, male, 6'4"-6'6", short straight brown hair, 20-25 years.
  6. Were you greeted within 30 seconds upon entering the location? YES X NO  
If No, how many seconds:  
  7. Were you asked for a smoking preference? YES X NO  
  8. Did the seater walk you to your table at a comfortable pace? YES X NO  
  9. Were children given special attention? N/A X YES   NO  
10. Did the seater extend a greeting such as "Enjoy your meal" before walking away?
YES X NO  
COMMENTS: (please explain all "NO" answers)
Aaron greeted us immediately upon entering the location.  We were asked if we had a smoking preference.  Aaron was very personable and chatted with us while walking us to the table at a comfortable pace.  He made sure the table was satisfactory and let us know the server would be with us shortly.  We did not have children in our party; however, we noticed the children in the restaurant were given crayons and paper to keep them busy.
SERVER/BARTENDER Name/Description: Melissa, female, 5'7"-5'9", long curly blonde hair, 20-23
11. Were you greeted within 2 minutes of being seated? YES   NO X
If No, how many minutes? 3.5 minutes
12. Did the server offer you a specific beverage? YES X NO  
If Yes, what was offered? Coke or Iced Tea
13. Did the server offer you a specific appetizer? YES X NO  
If Yes, what was offered? Cheese Fries or Buffalo Wings
14. Was the server knowledgeable of menu items? YES X NO  
What was asked: Was the Spinach Dip made fresh on-site, or was it received prepared.
What was said: The cooks make it fresh from scratch.
15. Did the server notify you of the daily specials? YES   NO X
16. Was the server genuinely friendly and attentive? YES X NO  
17. Did the server make you feel welcome? YES X NO  
18. Based on the service received, would you return to this location? YES X NO  
COMMENTS: (please explain all "NO" answers)
The location was very busy, so we were not greeted within two minutes; however, we felt the wait time was appropriate given the situation.  Our server was knowledgeable of menu items and seemed confident and comfortable with her answers.  She was very attentive and made herself available to the guests in her section.  Our server did not mention the daily specials, but did use suggestive selling techniques.  She attempted to upgrade our entree order by adding a salad bar.  We felt we were valued as customers and will surely return!
MANAGEMENT Name/Description: Chris, male, 5'8"-5'10", short black hair, 30's, wearing glasses.
19. Was the manager interacting with and available to the staff? YES X NO  
20. Was the manager well groomed and appropriately dressed? YES X NO  
21. Did you receive a table visit? YES   NO X
22. If there was a problem, was it handled efficiently and to your satisfaction?
N/A X YES   NO  
MAINTENANCE
23. Was the exterior well maintained and free from unnecessary debris? YES X NO  
24. Were the sidewalks well lit with no more than two bulbs not working? YES X NO  
25. Was the interior tile/carpet clean and well maintained? YES X NO  
26. Were the tables and utensils clean and free from spots? YES X NO  
27. Were the tables/chairs in good repair? YES X NO  
COMMENTS: (please explain all "NO" answers)
The manager was observed interacting with the staff and the customers in the location.  Although we did not specifically receive a table visit, the manager was seen stopping at several tables around us.  The location was about 95% full, and the manager was busy assisting the servers and bussing tables.  The interior and exterior of the location were well maintained throughout our visit.  The tables and chairs were in good repair with no visible flaws. 
FOOD ITEMS
First entrée ordered: Chicken Tender Platter   Second entrée ordered: 8oz. Ribeye Dinner
YES NO YES NO
Was the entrée attractively arranged? X   Was the entrée attractively arranged? X
Served at the correct temperatures? X     Served at the correct temperatures? X  
Prepared as ordered? X   Prepared as ordered? X
Did the entrée have a good flavour? X     Did the entrée have a good flavour? X  
Were the portion sizes adequate? X   Were the portion sizes adequate? X
Did you feel the entrée was a good value? X     Did you feel the entrée was a good value? X  
Would you order this item again? X     Would you order this item again? X  
Beverage Order: Iced Tea, Sprite
Appetizer Order: Spinach Dip
Dessert Order: Ice Cream Brownie Sundae
COMMENTS: (please explain all "NO" answers)
The entrée's were attractively arranged and served at the appropriate temperatures.  The Ribeye was asked to be prepared Medium Well, and was served Well Done.  Both entrée's had excellent flavor and the portion sizes of both exceeded our expectations.  We felt the entrée's were a good value for the price.
TIMING
Time Beverage Ordered: 6:56 PM   Beverage Delivered: 6:59 PM
Time Appetizer Ordered: 6:59 PM   Appetizer Delivered: 7:11 PM
Time Entrée's Ordered: 7:02 PM   Last Entrée Delivered: 7:23 PM
Time of server check back: 7:25 PM   Time of manager visit: 00:00 PM
Time Dessert Ordered: 7:44 PM   Dessert Delivered: 7:46 PM
Time of check delivery: 7:52 PM   Time of check pickup: 7:54 PM
OVERALL SATISFACTION
28. Based on this visit, would you return to this location? YES X NO  
29. Based on this visit, would you recommend this location to your friends? YES X NO  
COMMENTS: (please explain all "NO" answers)
The food at this location is excellent!  We received terrific service from our server.  All of the employees we came into contact with were very polite and seemed to genuinely enjoy serving others.  Given the full capacity of the location, we were extremely impressed with the service speed and food delivery!  We were very impressed by the hostess.  The hostess stand was near the salad bar.  A customer dropped one of the serving utensils on the floor and put it back on the counter.  The employee immediately removed the utensil and replaced it with a clean one.  We are looking forward to returning to this location and will most definitely refer our friends!  Thank you!