Store Managers

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/20xx

Store Manager Questionnaire
Store ID number __ __ __ __ Survey staff ID__ __ Survey number __ __ __ Date of interview __ __ /__ __ /__ __ __ __ Time of interview __ ___ : __ __ AM PM
A. Store Information
A.1 Name of store A.2 Store type: A.3 How many convenience stores are owned by the company? A.4. Did you know that your city has a Convenience Store Safety Ordinance which requires security features? If no to A.4, then skip to A.8 A.5 Did you know that the ordinance applied to your store? A.6 How did you hear about the ordinance? A.7 Do you understand what the ordinance requires? A.8 Is your store registered in your Police Department’s Convenience Store Safety Ordinance program? If no to A.8, then skip to B.1 A.9 Who registered your store? Did the store open before (enter the effective date of the ordinance)?	_________________________  Franchise-1 store Franchise-multiple stores  Single owner-multiple stores  Corporate chain store  Single owner operator-1 store  1 2-4  5-9 10-19  20-99  100+  Yes  No  Yes  No  N/A  Letter from police dept.  From trade association  Newspaper/radio  Other store owner  Community leader  Other, specify:_________  N/A  Yes  Some of it  No N/A  Yes  No  Unk  Your company registered itself  Registered by a trade organization  Other, specify______  N/A  Yes  No  Unk
B. Evaluation of Compliance Ordinance Requirements
Training B.1 Does the store provide training in robbery prevention to employees? If no, skip to question B.8 B.2 Who conducts the training? (check all that apply) B.3 How often do employees receive the training? (check all that apply) B.4 As part of your robbery prevention training, please indicate what employees are told to do during a robbery? (check all that apply) Obey robbers comments and give up the money Do not resist, argue, or fight Do not use weapons Maintain cash limits Lock store and call police Do not chase robber Warn robber about anything unexpected Keep robbery short and smooth Make robber visible Other, if yes, specify:___________________________________ B.5 Did the store provide robbery prevention training to employees before (enter the effective date of the ordinance)? B.6 Has the training changed since (enter the effective date of the ordinance)? If no to B.6, then skip to B.8 B.7 How did the training change?	 Yes  No  Unk  Police officer  Manager  Security consultant  Other, specify__________  Unk  N/A  Within 30 days after hire  Annually  Twice a year or more  No training given  Unk  N/A  Yes  No  Unk  N/A  Yes  No  Unk  N/A  Yes  No  Unk  N/A  Yes  No  Unk  N/A  Yes  No  Unk  N/A  Yes  No  Unk  N/A  Yes  No  Unk  N/A  Yes  No  Unk  N/A  Yes  No  Unk  N/A  Yes  No  Unk  N/A Yes After  Unk N/A Yes After  Unk N/A Provided more frequently New or additional content Different instructional format Other, specify: _____________________  N/A
Signage B.8 Were each of the following signages implemented before or after (enter the effective date of the ordinance)? (Check all that apply, before, after, or not implemented) a. No loitering or trespassing (signs at all public exits and on front, sides and rear of store) b. Surveillance cameras are in use c. Minimum cash is on hand d. Employee cannot open drop safe e. Security alarm system in use f. Height strips at all public exits	Before After N/I  Unk Before After N/I  Unk Before After N/I  Unk Before After N/I  Unk Before After N/I  Unk Before After N/I  Unk
Visibility B.9 Did the store implement a policy to keep unobstructed views from the cash register through outside doors and windows 3’-6’ above the ground before or after (enter the effective date of the ordinance)? (Check all that apply, before, after, or not implemented)	Before After N/I  Unk
Cash limit policy B.10 Does the store have a policy requiring a minimum amount of cash in the register? If no, skip to B.13 B.11 What is your cash limit? B.12 Did the store implement a cash limit policy before or after (enter the effective date of the ordinance)? B.13 Does the store have a drop safe? If no to B.13, skip to question B.17 B.14 Does the drop safe have a timed release? B.15 Is the safe bolted to the floor? B.16 Was the safe installed before or after (enter the effective date of the ordinance)?	 Yes  No  Unk __________ Before After N/I  Unk  Yes  No Unk  Yes  No N/A  Unk  Yes  No N/A  Unk Before After N/A  Unk
Alarm system B.17 Does your store have a silent panic or hold-up alarm system? If no, skip to question B.20 B.18 Is there a panic button at each register out of view of the customer? B.19 Was the alarm system implemented before or after (enter the effective date of the ordinance)? B.20 Does the store have automatic door locks which can be activated by the register? If no to B.20, then skip to B.22 B.21 Are employees instructed to activate locks during a robbery before the robber leaves the store?	 Yes  No  Unk  Yes  No N/A  Unk Before After N/I  Unk  Yes  No N/A  Unk  Yes  No N/A  Unk
Surveillance camera system B.22 Which features of your surveillance camera system were implemented before or after (enter the effective date of the ordinance)? (Check before, after or not implemented) Minimum of 2 color digital high-resolution surveillance cameras View of register View of main entrance/exit area Displays date and time of recording 24 hour operation Archives every 30 days	Before After N/I  Unk Before After N/I  Unk Before After N/I  Unk Before After N/I  Unk Before After N/I  Unk Before After N/I  Unk
Other security features B.23 What other security features were installed in the store in addition to those required by the ordinance before or after (enter the effective date of the ordinance)? If B.23 is none or unknown, skip to question B.25 B.24 Were these features added before or after the effective date of the ordinance?	 Security guards  Fenced in property  Lowering aisle height  Increased interior or exterior lighting  Other, specify __________  Unk  None Before After N/I  Unk
B.25 Explain reasons why the store complied to the ordinance requirements (Check all that apply)  To avoid crime  Good for business  Worth price to protect workers  Increases sales  Decreases employee stress  To be in compliance with ordinance  Other, specify_____________  Unk  N/A (Store did not comply to ordinance requirements) B.26 Explain reasons why the store did not comply with each ordinance requirement (Check all that apply; check A/A if store is in compliance with requirement): Training Too busy  too expensive  Unnecessary  Unaware of ordinance  Unk  N/A  Other, specify___ Signage Too busy  too expensive  Unnecessary  Unaware of ordinance  Unk  N/A  Other, specify___ Drop safe Too busy  too expensive  Unnecessary  Unaware of ordinance  Unk  N/A  Other, specify___ Visibility Too busy  too expensive  Unnecessary  Unaware of ordinance  Unk  N/A  Other, specify___ Alarms Too busy  too expensive  Unnecessary  Unaware of ordinance  Unk  N/A  Other, specify___ Cameras Too busy  too expensive  Unnecessary  Unaware of ordinance  Unk  N/A  Other, specify___ B.27 Do you have the responsibility to implement security features such as those required by the ordinance?  Yes  No
C. Registration and Training Materials
C.1 Did your store receive registration and resource training materials from your Police Department’s Convenience Store Safety Ordinance program? If no to C.1 then go to C.7 C.2 Who sent the materials to your store? C.3 Did you review the resource materials? C4 Did you understand the resource material? C.5 Were the materials useful? C.6 Why were some or all of the materials not useful?(Check all that apply) C.7 Do you need additional resource and training materials to comply with the city C-store security ordinance? If yes, what materials do you need? _______________________ C.8 Do you feel the police provides sufficient surveillance or presence in your store to protect employees and customers? If yes to C.8, then skip to D.1 C.9 Please explain what help you need from the police.			 Yes  No  Unk  Police department  Trade association  Other , specify____ Yes No N/A Unk Yes No N/A Unk Yes No N/A Unk  Insufficient information  Did not need materials  Regional manager or owner received them, not your responsibility  Other, specify_____  N/A  Unk  Yes  No  Unk  Yes  No  Unk __________________
D. Robbery risk factors
D.1 Are there commercial businesses open 24 hours within 100 feet from your store? D.2 Is the store located within one mile of: Known drug trafficking activity Loitering youth, gangs, pan handlers or prostitutes Subsidized public housing projects Privately owned multi-family dwellings Areas with broken windows, graffiti, or abandoned cars on empty lots.			 Yes  No  Unk  Yes  No  Unk  Yes  No  Unk  Yes  No  Unk  Yes  No  Unk  Yes  No  Unk
E. Benefits from compliance
E.1 Did sales increase, decrease or stay the same since (enter the effective date of the ordinance)? If E.1 is same or unknown, then skip to E.3 E.2 What percentage did your sales increase or decrease? E.3 How much was your total sales in 2010. E.4 Overall return on investment from compliance? E.4 Did the following problems occur in the store less or more frequently, or no difference since (enter the effective date of the ordinance)? Loitering Gang activity Drug activity Shoplifting Theft Robbery Assaults to employees E.5 Did the following problems occur in the neighborhood less or more frequently or no difference since (enter the effective date of the ordinance)? Loitering Gang activity Drug activity Shoplifting Theft Robbery Assaults to employees E.6 Please indicate whether the following items increased, decreased, or stayed the same since (enter the effective date of the ordinance)? a. Property value of the store? b. Employee turnover rate? c. Employee morale? d. Employee absenteeism? e. Storage capacity or in inventory on floor? f. Utility bills? g. Greater repeat customers? Improved or better clientele? Employee stress from threat of workplace violence			 Increased  Decreased Same  Unk <5% 5-9% 10-19%  20+%  Unk Total sales:_____  Positive return on investment  Negative return on investment  Not applicable-not in compliance  Unk  L  M  ND  Unk  L  M  ND  Unk  L  M  ND  Unk  L  M  ND  Unk  L  M  ND  Unk  L  M  ND  Unk  L  M  ND  Unk  L  M  ND  Unk  L  M  ND  Unk  L  M  ND  Unk  L  M  ND  Unk  L  M  ND  Unk  L  M  ND  Unk  L  M  ND  Unk  Decreased  Increased  No change  Unk  Decreased  Increased  No change  Unk  Decreased  Increased  No change  Unk  Decreased  Increased  No change  Unk  Decreased  Increased  No change  Unk  Decreased  Increased  No change  Unk  Decreased  Increased  No change  Unk  Decreased  Increased  No change  Unk  Decreased  Increased  No change  Unk  None
F. Cost of security features
F.1 What is an estimate of the store’s cost to comply with the ordinance to implement the following requirements? (Keep in mind product planning, implementation and maintenance) Training Alarms Drop safes Surveillance cameras			$_______  Unk $_______  Unk $_______  Unk $_______  Unk
G. Number of crimes during past three years
G.1 Please record the number of the following crimes which at your store occurred during 2009, 2010, and 2011? (If unknown, enter UNK) 2009 2010 2011 a. Robbery _____ _____ _____ Were you working during any of these robberies?  Yes  No  Yes  No  Yes  No Non-fatal injury from assault to a worker during a robbery _____ _____ _____ Non-fatal injury from assault to a customer during a robbery _____ _____ _____ Homicide of a worker during a robbery _____ _____ _____ Homicide of a customer during a robbery _____ _____ _____ Non-fatal injury of a worker from assault not due to robbery _____ _____ _____ Homicide of a worker not due to robbery _____ _____ _____ Sexual assault of a worker _____ _____ _____
H. Information on the manager
H.1 Are you the owner of the store? H.2 What is your age? H.3 What is your gender? H.4 What is your highest educational attainment? H.5 Were you born in the U.S.? If yes go to question 55 If no, what country were you born in: H.6 What is your race? H.7 What is your ethnicity? H.8 How long have you worked in a C-store?			 Yes  No  N/A  16-19 years  20-24 years  25-34 years  35-44 years  45-54 years  55-64 years  65 years and over  Male  Female  Some high school  Completed high school/GED  Some college  Associate’s degree  Bachelor’s degree  Master’s degree  Professional degree  Doctoral degree  Other  Yes  No  N/A ________________ a. White b. Black or African American c. American Indian, Alaskan Native d. Asian e. Native Hawaiian or Pacific Islander f. Other g. Multiple races h. Unknown  Latin American  Eastern Asia (i.e. China, Korea, Japan)  South Eastern Asian (i.e. Vietnam, Cambodia)  South Central Asian (i.e. Indian, Iran, Pakistan)  Western Asian (i.e. Iraq, Saudi Arabia, Israel, Jordan, Syria)  African  North American /European  Other, Specify _____  Unknown  <1 year  1-4 years  5-9 years  10 or more years
I. Information on store clerks
I.1 How many clerks are employed? a. In the store? b. On the third shift (10:00P.M. to 6:00 A.M.) (record N/A if no third shift) I.2 Please provide the number of store clerks employed by age group I.3 Please provide the number of store clerks employed by gender I.4 Please provide the number of store clerks employed by born or not born in U.S. I.5 Please provide the number of store clerks employed by race I.6 Please provide the number of store clerks employed by ethnicity I.7 Please provide the number of store clerks employed by how long they worked for the C-store			Number: ___ Number: ___ a. 16-19 years ___ b. 20-24 years ___ c. 25-34 years ___ d. 35-44 years ___ e. 45-54 years ___ f. 55-64 years ___ g. 65+ ___ a. Male ___ b. Female ___ a. U.S. ___ b. Not born in U.S. ___ a. White ___ b. Black or African American ___ c. American Indian, Alaskan Native ___ d. Asian ___ e. Native Hawaiian or Pacific Islander ___ f. Other ___ g. Unknown  Latin American ___  Eastern Asia (i.e. China, Korea, Japan) _____  South Eastern Asian (i.e. Vietnam, Cambodia) _____  South Central Asian (i.e. Indian, Iran, Pakistan) _____  Western Asian (i.e. Iraq, Saudi Arabia, Israel, Jordan, Syria) _____  African _____  North American /European _____  Other, Specify _____  Unknown a. <1 year ___ b. 1-4 years ___ c. 5-9 years ___ d. 10 or more years ___
J. Police enforcement
J.1 Has the store been cited by the police for being out of compliance with the city’s convenience store ordinance since (enter the effective date of the ordinance)? If No, skip to end J.2 How many times were you cited for noncompliance? J.3 What was the total cost of the fines for all citations? J.4 Was your compliance a direct result of the citation?		 Yes  No  Unk Number _____  Unk Total cost________  Unk  Yes  No  N/A  Unk

Store Evaluation Form
A. Store Information (pre-recorded)
Store ID number __ __ __ __ Name of store____________________________________________________________ Company name___________________________________________________________ Store address_____________________________________________________________ Store telephone number __ __ __ -__ __ __ -__ __ __ __ Date of store site visit __ __ /__ __ /__ __ __ __ Time of store visit __ ___ : __ __ AM PM Store is registered in Police Department’s compliance program  Yes  No Survey staff ID __ __
B. Ordinance Requirements
Registration Ordinance compliance Program registration sticker is posted	 Yes  No
Signage Signs posted saying the following: No loitering or trespassing (signs at all public exits and on front, sides and rear of store) Surveillance cameras are in use Minimum cash is on hand Employee cannot open drop safe Security alarm system in use Are there height strips at all public exits	 Yes  No  Yes  No  Yes  No  Yes  No  Yes  No  Yes  No
Visibility Unobstructed view of outside from cash register through all windows and public access doors extending from 3 to 6 feet above the ground.	 Yes  No
Alarms 5 Silent panic or holdup alarm system evident in store	 Yes  No
Surveillance camera system Minimum of two surveillance cameras View of register View of main entrance/exit area	 Yes  No  Yes  No  Yes  No
C. Other CPTED features
Access/escape routes A person outside can be observed from the register station before entering store There is opportunity for a person outside to hide from customers and clerks in store Access to parking lot is visible from within store? Property is fenced to force entrance and exit in view of register	 Yes  No  Yes  No  Yes  No  Yes  No
Interior visibility Are mirrors used to view rear aisle areas Does the shelf height block view of persons in aisles Is there a place to hide which is not visible from cash register	 Yes  No  Yes  No  Yes  No
Bullet-resistant shielding Is bullet resistant shielding around cash register? If no to 16 then go to 18 Is bullet resistant shielding in use? Does the store have a pass-through cash box? Is there a security guard present?	 Yes  No  Yes  No  Yes  No  Yes  No
Store characteristics Does store have a off-street parking lot? Are there multiple clerks present? Is store open 24 hours? Is store located in a strip mall? Is store located within ½ mile of an expressway? Does store have gas pumps? Describe store type: Is the store located within one mile of: Known drug trafficking activity Loitering youth, gangs, pan handlers or prostitutes Subsidized public housing projects Privately owned multi-family dwellings Areas with broken windows, graffiti, or abandoned cars on empty lots.	 Yes  No  Yes  No  Yes  No  Yes  No  Yes  No  Yes  No  Convenience  Gasoline station with nightly closed kiosk with pass thru cash box  Gasoline station with nightly open kiosk without pass thru cash box  Small grocery store  Other, describe___  Yes  N o  Unk  Yes  No  Unk  Yes  No  Unk  Yes  No  Unk  Yes  No  Unk

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Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).