SAMPLE
EVIDENCE CHECKLIST - LABOR CODE 6404.5
Smoke-free Bars, Restaurants and Gaming Clubs

1. PARTY CITED: Patron______ Owner______ Bar Staff_____

2. DOES ESTABLISHMENT HAVE EMPLOYEES? Yes___ Number Present____

3. OWNER PRESENT? Yes_____ No_____

4. OFFICER WITNESSED SMOKING BY:

Patron(s)_______ Owner_______ Bar Staff ______

Number of parties observed smoking ?_________________

NOTE: Bar staff smoking behind the bar is also a violation of the CA Uniform Retail Food Facilities Law - CA Health and Safety Code Division 104, Part 7, Chapter 4, section 114020(d).

5. “NO SMOKING” SIGNS POSTED AT ALL ENTRANCES? Yes___ No___

6. ASHTRAYS PRESENT? Yes________ No________

Approx. Number_________ Color__________ Type_____________

Were they all the same?__________________

Other receptacles being used to hold ashes?_______________________________

7. BRAND OF CIGARETTES BEING SMOKED:

NOTE: Clove cigarettes and Beedies (Bidis) contain tobacco. Smoking them in an enclosed workplace is a violation of this law.

Alpine___
GPC___
Newport___
Basic ___
Harley Davidson___
Old Gold___
Benson & Hedges___
Kent___
Pall Mall___
Camel ___
Kool___
Players___
Chesterfield ___
Lark___
Saratoga___
Doral ____
Lucky Strike___
Viceroy___
Eve ___
Marlboro___
Virginia Slims___
Other__________________________

PATRON STATEMENTS: Was patron asked by staff not to smoke? Yes___ No____

Did staff provide the ashtray? Yes___ No___ Light patron’s cigarette? Yes___ No___

OTHER WITNESS STATEMENTS:_____________________________________________
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Reviewed by Santa Clara County Dist. Atty. Office June ’99 Distributed by BREATH