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Restaurant Food Allergy & Allergen Safety Survey Template

Collect diner feedback on allergen communication, cross-contact, and safety practices in restaurants. Customizable, ready to use; 5–7 minutes.

What's Included

AI-Powered Questions

Intelligent follow-up questions based on responses

Automated Analysis

Real-time sentiment and insight detection

Smart Distribution

Target the right audience automatically

Detailed Reports

Comprehensive insights and recommendations

Sample Survey Items

Q1
Dropdown
In the past 3 months, how often have you dined at restaurants?
  • Daily or almost daily
  • A few times per week
  • About once per week
  • 2–3 times per month
  • About once per month
  • Less than once per month
Q2
Multiple Choice
Which of the following describe your dining in the past 12 months? (Select all that apply)
  • I have a diagnosed food allergy
  • I have a suspected allergy or intolerance
  • I avoid certain foods for non-allergy reasons
  • I regularly dine with someone who has a food allergy
  • None of these
Q3
Multiple Choice
Which allergens do you or your usual dining party avoid? (Select all that apply)
  • Peanuts
  • Tree nuts
  • Milk/dairy
  • Eggs
  • Soy
  • Wheat/gluten
  • Fish
  • Shellfish
  • Sesame
  • Sulfites
  • None of these
Q4
Matrix
When dining out in the past 6 months, how often did you or your party do the following?
RowsNeverRarelySometimesOftenAlwaysNot applicable
Tell the server about the allergy••••••
Ask for the allergy to be noted on the order••••••
Ask about cross-contact prevention••••••
Verify ingredients with a manager or chef••••••
Check menu/allergen info online before visiting••••••
Q5
Opinion Scale
In the past 6 months, how confident are you that staff understand and handle allergy requests?
Range: 1 – 10
Min: Not confidentMid: NeutralMax: Very confident
Q6
Rating
How clear has menu allergen information been where you dined in the past 6 months?
Scale: 10 (star)
Min: Very unclearMax: Very clear
Q7
Multiple Choice
Which ways do you prefer to communicate allergy needs to a restaurant? (Select all that apply)
  • Tell the server in person
  • Add notes to an online order
  • Call ahead
  • Add notes to a reservation
  • Ask to speak with a manager
  • Provide a printed allergy card
Q8
Multiple Choice
Attention check: To confirm you are paying attention, please select “Often” below.
  • Never
  • Rarely
  • Sometimes
  • Often
  • Always
Q9
Multiple Choice
In the past 12 months, did you or your party experience any allergy-related incidents while dining out?
  • No incidents
  • Suspected cross-contact but no symptoms
  • Mild reaction managed without medication
  • Reaction requiring medication (e.g., antihistamine, epinephrine)
  • Severe reaction requiring urgent medical care
  • Prefer not to say
Q10
Ranking
Please rank the features that make you feel safest when dining with allergies (most to least important).
Drag to order (top = most important)
  1. Clearly marked allergens on the menu
  2. Staff explicitly repeat back allergy notes
  3. Server or manager confirms with the kitchen
  4. Evidence of separate prep area or tools
  5. Chef/manager visits the table to discuss
  6. Dedicated fryers or cooking surfaces
Q11
Long Text
What could restaurants do to better support safe allergy dining? Please be specific.
Max 600 chars
Q12
Dropdown
What is your age?
  • Under 18
  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65 or older
  • Prefer not to say
Q13
Multiple Choice
Which gender do you identify with?
  • Woman
  • Man
  • Non-binary
  • Prefer not to say
Q14
Multiple Choice
Where do you primarily dine?
  • North America
  • South America
  • Europe
  • Africa
  • Middle East
  • Asia
  • Oceania
  • Prefer not to say
Q15
Multiple Choice
What is the highest level of education you have completed?
  • Less than high school
  • High school or equivalent
  • Some college/Associate degree
  • Bachelor’s degree
  • Postgraduate degree
  • Prefer not to say
Q16
Multiple Choice
What is your current employment status?
  • Employed full-time
  • Employed part-time
  • Self-employed
  • Unemployed and looking for work
  • Student
  • Homemaker/Caregiver
  • Retired
  • Unable to work
  • Prefer not to say
Q17
Long Text
Any final comments about dining with food allergies?
Max 600 chars
Q18
AI Interview
AI Interview: 2 Follow-up Questions on Dining with Food Allergies
AI InterviewLength: 2Personality: Expert InterviewerMode: Fast
Q19
Chat Message
Thank you for participating! Your feedback helps improve allergy-safe dining.

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