Language:
English
عربي
PROJECT : ELARA - (Forecourt)
Adnoc
Eppco - Enoc
Emarat
Shopper ID
:
Serial No:
:
Staff Info
Operator Code:
:
CSA Name
CSA Number
Gender
:
Male
Female
Emirate
:
Height
:
Tall
Medium
Small
Site ID
:
(861 - SHAHAMA)
Built
:
T
M
F
# of Staff
:
Spectacles
:
Yes
No
Date
:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
2011
2012
(dd-mm-yyyy)
Beard
:
Yes
No
Amount (Dhs)
:
Mustache
:
Yes
No
# of Vehicles
:
Time In
:
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
:
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
( hh:mm)
Ethnic Groups
:
Indian
Pakistani
Filipino
Expat. Arabs
Others
Time Out
:
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
:
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
( hh:mm)
Other Ethnic Groups
:
Time of Visit
:
1. APPROACH
Scores
Critical Areas
Yes
No
N.A.
N.A.
1.
Was signage visible from distance of 500 meters and well maintained? Can be included only in first run
2
2.
Were lights working and in good condition at the approach?
2
3.
Were the lights working and in good condition at the forecourt area?
4
4.
Was filling area / forecourt clean and tidy?
2
5.
Were the driveway and forecourt free of potholes and well maintained?
2. GREETINGS
Scores
Critical Areas
Yes
No
N.A.
5
6.
Was there any delay in approaching customers at the fuel pump
5
7.
Did the staff approach the driver side of the vehicle?
5
8.
Were you greeted in a friendly manner (pleasant feeling)?
If no, please describe behavior: Was it arrogant, without any expression, normal etc….
4
9.
Did they request customers to quit smoking?
5
10.
Did the staff thank you as you were leaving?
DID NOT SAY ANYTHING
3. APPEARANCE AND BEHAVIOR OF STAFF
Scores
Critical Areas
Yes
No
N.A.
5
11.
Was the filling staff presentable and well groomed?
4
12.
Was he able to communicate with customer?
5
13.
Was the attendant wearing visible nametag?
COULD NOT READ
6
14.
Was staff courteous / friendly?
4. SERVICE
Scores
Critical Areas
Yes
No
N.A.
2
15.
Did he follow the instructions on the Rahal (Fuel Card)?
6
16.
Did he confirm and repeat amount and type of fuel?
6
17.
Did he fuel as per customer’s instructions - Dhs?
5
18.
Did he offer to clean windscreen voluntarily? (front & back)
5
19.
Were you charged the correct amount?
6
20.
Were you given correct change?
21.
Did he provide information about any promotions at Service Station? (only in case of active promotion)
5. REST ROOMS
Scores
Critical Areas
Yes
No
N.A.
3
22a.
Were they adequately stocked with all necessary supplies such as soap?
22b.
Were they adequately stocked with all necessary supplies such as toilet tissue?
22c.
Were they adequately stocked with all necessary supplies such as paper towels?
(paper towels are not required where fully operational hand dryers exist)
3
23a.
Were sinks clean?
23b.
Were mirrors clean?
23c.
Were hand dryers clean?
23d.
Were dispensers clean?
23e.
Were toilets and urinals clean?
2
24a.
Were doors clean?
24b.
Were walls clean?
24c.
Were ceiling clean?
24d.
Were vents clean?
24e.
Were floors clean?
24f.
Were baseboards clean?
24g.
Were grout clean?
2
25a.
Were trash containers clean?
25b.
Were trash containers not overflowing?
2
26.
Was the restroom smelling clean & fresh (without any offensive odor) ?
2
27.
Were all the facilities inside the restroom in good working condition ?
2
28.
Was the Mosque premises clean ?
Attach Bills
File # 1
PDF Questionnaire
COMMENTS
CSA WAS WEARING NAME TAG BUT COULD NOT READ
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