1. Status kariawan Usia : Status Lajang : Menikah : Cerai :
Jenis kelamin Laki-laki : orang Perempuan : orang
Pendidikan Sarjana : SMA : SMP :
Etnik
Agama Islam : orang Lain lain : .................= orang
2. Bagaimanakah kebijakan institusi yang berlaku di restoran ini ?
.......................................................................................................................................... .......................................................................................................................................... ............................................................................................................................... 3. Bagaimanakah Bentuk peraturan yang dibentuk oleh direktur kepada kariawan restoran? .......................................................................................................................................... .......................................................................................................................................... ............................................................................................................................. 4. Apakah terssedia televisi, surat kabar, majalah; dan bagaimanakah cara mengaksesnya? .......................................................................................................................................... .......................................................................................................................................... ............................................................................................................................ 5. Observasi bahan makanan Bagaimanakah metode untuk seleksi dan penerimaan bahan makanan? .............................................................................................................................. ..................................................................................................................
Bagaimana cara penangan dan menyiapkan bahan makanan?
.............................................................................................................................. .............................................................................................................................. Bagaimanakah cara memasaknya? .............................................................................................................................. .............................................................................................................................. Bagaimana cara penyajiannya? .............................................................................................................................. .............................................................................................................................. Bagaimana Kebersihanya? .............................................................................................................................. ..............................................................................................................................
6. Observasi Kebersihan ruangan
Apakah tersedia loker untuk masing-masing kariawan? .............................................................................................................................. ............................................................................................................................. Apakah terdapat tempat sampah? .............................................................................................................................. ............................................................................................................................. Apakah ktersedia tempat penampung sampah sementara? .............................................................................................................................. .............................................................................................................................. Bagaimanakah distribusi sampah yang digunakan? .............................................................................................................................. .............................................................................................................................. Apakah tersedia peralatan pelindung ruangan, misalnya: alat pencegah tikus, serangga dsb? Sebutkan! .............................................................................................................................. .............................................................................................................................. ..............................................................................................................................
7. Observasi Air dan sanitasi
Apakah air yang digunakan bersih dan mencukupi kebutuhan penggunaan? .............................................................................................................................. .............................................................................................................................. .................................................................................................................. Sumber air yang digunakan? .............................................................................................................................. ..............................................................................................................................
Apakah tersedia washtafel?
.............................................................................................................................. .............................................................................................................................. Bagaimanakah kriteria tempat cuci peeralatanya? .............................................................................................................................. .............................................................................................................................. Bagaimanakah kriteria tempat cuci bahan makanya? .............................................................................................................................. .............................................................................................................................. Saluran pembuangan air terbuat dari apa? Apakah dapat menyaring lemak? .............................................................................................................................. .............................................................................................................................. .................................................................................................................. Toilet Berapakah yang disediakan? .............................................................................................................................. .............................................................................................................................. Apakah ada tempat untuk wanita dan pria? .............................................................................................................................. .............................................................................................................................. Apakah dibedakan antara kariawan dan tamu? .............................................................................................................................. ..............................................................................................................................
