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State of Florida

Office of the Attorney General

CONVENIENCE BUSINESS SECURITY INSPECTION FORM

PART A:

Date of Inspection: _____/_____/_____

Time: _____

Case Number: _______________

(OAG use only)

Type of Inspection:

Routine

Follow-up

Complaint

Business (Store) Name:

Store No:

Business (Store) Street Address:

Business (Store) City:

State: FL

Zip:

Business (Store) Telephone Number:

(

)

Corporation/Owner Information (as listed on business license, if different from above)

Corporation Name:

Corporation Street Address:

Corporation City, State, Zip:

PART B: Is the business closed between 11:00 p.m. and 5:00 a.m.?

yes

Is the owner or owner’s immediate family working between the hours of 11:00 p.m. and 5:00 a.m.?

yes

If the answer to either of the previous questions is yes, this inspection form is not applicable to the business.

PART C: Minimum Standards Required by the Convenience Business Security Act, Sections 812.1701-812.176, F.S.

Viol.

Not

Yes

Security Standards

Code

Inspected

Is the parking lot illuminated?

Does window tinting allow physical identification of persons in the sales

transaction area from outside the building?

Does the window signage allow physical identification of persons in the

sales transaction area from inside and outside the building?

Is there a notice at the entrance that the cash register contains less than

$50?

Is there height marker at the entrance?

Is there a silent alarm to law enforcement or a private security agency,

or is there proof of exemption from the requirement?

Is there a secure drop safe or cash management device?

Is there a security camera system capable of retrieving an identifiable

image of an offender?

Is there a cash management policy on-site?

Has robbery deterrence and safety training been provided to retail

employees?

If the answer to any of the above questions is ―No‖, explain below. Attach additional sheets as necessary.

PART D: If a robbery, sexual battery, aggravated assault, aggravated battery, kidnapping or false imprisonment has

occurred at the convenience business within the past 24 months, the business must, between the hours of 11:00 p.m.

and 5:00 a.m., meet one of the requirements described below. Attach a copy of the agency incident report of the

offense, if applicable.

Date of Incidence:

Type of Incidence:

Agency Case No:

Viol.

Not

Yes

Security Standards

Code

Inspected

Are there two or more employees?

Is there a secured safety enclosure of transparent polycarbonate?

Is there a security guard on the premises?

Is the business locked and transactions accomplished through a trough,

trap door or window?

PART E: Certification – I hereby attest that the convenience business identified above

is in compliance

is not in

compliance with the provisions of sections 812.1701-812.176, F.S. and Chapter 2A-5, F.A.C.

_______________________________________

____________________________________________

Inspector’s Name (Print)

Inspector’s Agency and Telephone Number

_______________________________________

____________________________________________

Inspector’s Signature

Store Manager or Employee Signature

Date of Signature

CBS-2

White—OAG

Yellow—Inspector

Pink—Optional/Business

Revised 4/09

Rule # 2A-5.011

Convenience Business Security Inspection Form - State Of Florida, Office Of The Attorney General

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