WELCOME TO THE
HUNTERDON COUNTY DEPARTMENT OF HEALTH
Environmental Health Services

NAME OF INSPECTOR: DATE OF INSPECTION:

PLEASE CHECK THE TYPE OF FACILITY YOU OWN/MANAGE:

1. Was your facility inspected as a -

2. Was the purpose of the visit clearly explained at the start of the inspection?

3. Did the inspector communicate in a way that was clear and easy to understand?

4. Did you have the opportunity to ask questions?

5.  If violations were cited at your facility….

a) Did the inspector explain the health implications of the violation?

Yes

No

Comments

b) Did the inspector explain the code that is being violated?

Yes

No

Comments

6.  Was the interaction with staff:  (Please check all that apply)

7. Is English your native language?

Yes

No

If not, what is your native language?

8. If you have any specific feedback or concerns about an inspector, please provide it here:

IF YOU WOULD LIKE A RESPONSE, PLEASE PROVIDE YOUR NAME AND CONTACT INFORMATION BELOW:

Name (optional)
Phone (optional)
Email (optional)