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SIll/( ,,'ll' Co,","unil)"i>b~«O COlllro/ Rfst'ard. <br />Standardized <br />Tobacco <br />Assessment for <br />Retail Settings: <br />Vape Shops <br />(vSTARS) <br />Beta Version 08/04116 <br />Start time: _________ _ <br />End time: _________ _ <br />1. Date of visit : ______ _ 2. Store 10: _____ 3. Coder 10: _____ _ <br />4 . Store Name: Does the actual store name match the assigned store name? <br />0, Yes <br />00 No -Enter correct name: ____________________ _ <br />5. Store Location: Does the actual store address match the assigned address? <br />0, Yes <br />00 No -Enter correct address: ____________________ _ <br />6. Can you survey this store? [If not, then select an option below and STOP.] <br />0, Yes, I can <br />O2 No, store does not exist <br />0] No, store is closed <br />D. No, membership or fee required to enter <br />05 No, environment unsafe for me <br />0 6 No, asked to leave before completing the survey 0 <br />7 <br />Other (specify): ______________________ _ <br />7. Does this store sell vaping products? <br />0, Yes (Continue to question #8) <br />00 No (Discontinue this survey) <br />STORE DE MOGRAP HICS <br />8. Is this store best categorized as a ... <br />0, Vapeshop <br />O2 Vape kiosk <br />0] Head shop with vaping products <br />D. Convenience store; pharmacy; beer/wine/liquor store; grocery store/supermarket; <br />mass merchandiser/discount store -> use STARS 0, Other: ___________________________ _ <br />9. Exterior sign stating policy regarding minors entering the store? <br />0, Minimum age must be 18 or older to enter <br />O 2 Minimum age must be 19 or older to enter <br />0] Minimum age must be 21 or older to enter <br />00 No minimum age posted to enter <br />10. Does the store sell ... <br />a. Alcoholic beverages? <br />0, Yes <br />00 No <br />b. Cannabis / Marijuana? <br />0, Yes <br />00 No <br />c. Whipped cream chargers or dispensers (used for whippets)? <br />0, Yes <br />Do No <br />d. Other psychoactive substances (e .g., kratom, K2 "spice~ synthetic cannabinoids such as <br />"herbal incense" or "Scooby Snax~ salvia)? <br />0, Yes <br />00 No <br />TYPES OF PRODUCTS SOLD <br />11. Tobacco devices or products sold : <br />a. Cigarettes? 0, Yes DoNo <br />b. Cigarillos/little cigars? 0, Yes DoNo <br />c. Large Cigars? 0, Yes DoNo <br />d. Pipe or roll your own tobacco? 0, Yes DoNo <br />e. Smokeless tobacco products? 0, Yes DoNo <br />f. Hookah pipes / Water pipes? 0, Yes DoNo <br />g.Shlsha? 0, Yes DoNo