Ellensburg Smoke Shop Environmental Scan

A. Store Information
1. Store Name
2. Store Address
3. Store Type / Convenience Smoke Shop
4. Disposition / Interior and Exterior Data Collected
Interior Collection Denied, Only Exterior Data Collected
5. Date of Review: / 6. Time of Day:
7. Surveyor Initials:
B. Store External Factors
8. Does the store have exterior “age of sale” signs Yes No
9. # of “Age of Sale” signs: / We Card / Other / Other
10. Are marijuana/paraphernalia laws posted outside of the store? Yes No
11. Does the store have exterior marijuana/marijuana paraphernalia advertising?
Yes No
12. Are there marijuana/paraphernalia ads on the door? Yes No
13. Are there marijuana/paraphernalia ads on windows? Yes No
14. Total # of exterior ads:
15. Check the percentage closest to matching the total ad coverage of doors, walls and windows outside the store: 0% up to 10% up to 25% up to 50% up to 75% up to 100%
16. Is there trash or drug paraphernalia outside? Yes No
17. Are any of these locations in site of the store? Schools Parks
Churches Youth Centers
18. # of people who walked by the store in 5 minutes:
19. # of cars that drove by the store in 5 minutes:
C. Store Internal Factors
20. Does the store have interior “age of sale” signs Yes No
21. # of “Age of Sale” signs: / We Card / Other / Other
22. Does the store have age calendars? Yes No
23. Are marijuana/paraphernalia laws posted inside of the store? Yes No
24. Does the store have interior marijuana/marijuana paraphernalia advertising?
Yes No
25. Are there marijuana/marijuana paraphernalia ads on the door? Yes No
26. Are there marijuana/paraphernalia ads on windows? Yes No
27. Check the percentage closest to matching the total ad coverage of doors, walls and windows inside the store: 0% up to 10% up to 25% up to 50% up to 75% up to 100%
28. Total # of interior marijuana/marijuana ads:
29. Location of paraphernalia: Secluded Out in the open
30. # of paraphernalia items on counters:
31. # of paraphernalia items in front of or beside counters:
32. # of paraphernalia items within 5’ of front door:
33. # of paraphernalia items below counter level:
34. # of paraphernalia items near food/drink:
35. Are sales people attentive to people in the stores? Yes No
D. Notes

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