Business Address:

D/B/A Name :

Nbr Of Floors:

Time In: Time Out:

AM

PM

AM

PM

Store Manager: Scanning Coordinator: Nbr of Scanners at Location:

Investigator's Name:

Schedule Date:

Inspection Date:

_

IRIS NUMBER: SITE NUMBER:

Store Size: Item count at check out: Incorrectly scanned count:

This inspection report was discussed and reviewed by: Print Mgr. / Owner Name:

Mgr. / Owner's Signature: Date:

OFFICE USE ONLYNOTE: THE FINAL RESULTS OF THIS INSPECTION WILL BE DETERMINED BY THE REVIEWING SUPERVISOR

PASS FAIL Supervisor's Signature: Data Entered into Account Queue:

Investigator's Signature: Badge Nbr:

License Type #: Expired Date:/ / /

_

City: State: Zip:

_

CERTIFICATEA.

PRICING / UNIT PRICEB.

DOUBLE CHECK PROCEDUREC. D.

RECEIPT REQUIREMENTSE. F.

ADVERTISEMENTG. H.

SHELF TAGS & SIGNS

SCANNING TEST / DEVICES / EQUIPMENT

POLICIES

A.P.S. Rule 2Requirement for Price MarkingPrice Marking pending A.P.S. certification.

A.P.S. Rule 5 A.P.S. Rule 17Reconstituted Infant Formula may disclose on the Shelf Labels - Unit Price per oz after water is added.

A.P.S. Rule 18Pre-packaged Items that do not have UPC symbol or capable of being electronically scanned must be price marked.

Unit PricingUnit Pricing UniformityUS Dollar and Cents

A.P.S. Rule 11Double Check Procedure

Employee Designated: to verify price

Proper Placement of Labels and Signs

A.P.S. Rule 19Correction of Scanning Errors

Correction of Scanning Errors

A.P.S. Rule 15Shelf Labels

Label affixed to shelf

Promptly Correcting Price Marking discrepancies

A.P.S. Rule 16 Non-Shelved Labels

Brand Name - if anyName of Item

Sale Dates ( If Applicable )Current Price (Reg./Sale)

Size Requirements for Sign (5x7 min)Brand Name- if anyName of Item

Sale Dates ( If Applicable )Current Price (Reg./Sale)

Size Or Weight Or Measure Or Count

A.P.S. Rule 13Receipt Requirements

Receipt to CustomerDate of TransactionBusiness Name

Business Telephone NbrBusiness Address

Discount Card RequirementProduct I.D.Price of Item

Total Purchase AmountAmount of Sales Tax

A.P.S. Rule 14Printed Advertisements

Size Or Weight Or Measure Or CountAdv. Available to general publicSales DatesDisplayed at central location/each level

A.P.S. Rule 27Scanning Devices/Equipment

A.P.S. Rule 22 A.P.S. Rule 12Point of Sale Device

Notification of Change in Device / Equipment

Overcharge no more than 4% of the total number of items selected

Visible IndicationsView by Customer's Position

A.P.S. Rule 20Refund - Return - Check Writing Policies

Posted at each registerPosted at customer service desk or central locationWritten copy available at customer request

View Price

CITY OF CHICAGODEPARTMENT OF BUSINESS AFFAIRS AND CONSUMER PROTECTION

ALTERNATIVE PRICING SYSTEMINSPECTION

Ward Nbr: