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1. What date was the inspection on? (Required.)

Date

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2. Who was your inspector? (Required.)

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3. What is the Establishment name and phone number? (Required.)

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4. What is the license number? (Required.)

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5. Did the inspector introduce themselves, show identification and provide a business card upon arrival? (Required.)

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6. Around what time did the inspector arrive? (Required.)

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7. About how long did the inspection last? (Required.)

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8. At the completion of the inspection, did the inspector review the violations with you and explain what was need to become complaint with the health and safety requirements? (Required.)

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9. DId you recieve a copy of the Inspection Report via email/mail immediately after inspection? (Required.)

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10. Do you have anything additional information you would like to add?

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