Retail Food Establishment Inspection Report Page 3
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3Texas Department of State Health Services
Retail Food Establishment Inspection Report
Establishment Name:
Physical Address:
City/State:
License/Permit #
Page __ of __
TEMPERATURE OBSERVATIONS
Item/Location
Temp
Item/Location
Temp
Item/Location
Temp
OBSERVATIONS AND CORRECTIVE ACTIONS
Item
AN INSPECTION OF YOUR ESTABLISHMENT HAS BEEN MADE. YOUR ATTENTION IS DIRECTED TO THE CONDITIONS OBSERVED AND
Number
NOTED BELOW:
Received by:
Print:
Title: Person In Charge/ Owner
(signature)
Inspected by:
Print:
Samples: Y N
# collected ____
(signature)
Form EH-06 (Revised 09-2015)
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Parent category: Legal