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CANTEEN HYGIENE SURVEILLANCE

Canteen Location:		Manpower:	Daily Caterer No:
Supervisor:	Daily Catering No:	Date:
Previous Survellance Date:	Observation:	Open / Total :

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क्रमांक		हां/नहीं	Sr.No		Yes/No	Observation and remark	क्रमांक / Sr.No		हां/नहीं / Yes/No	Observation and remark
	/	Yes No

Observation of consern	Capa	Communication Notes

Responsibility	Completion Date	Status and closing remarks

Signature of Survellance :

Signature of Survellance :

Sign of Canteen Supervisor/Admin Head :

Signature of Medical Officer :

Signature of Medical Officer :