1

Date and hour of Inspection (stating
whether expected or not)

2

Name, pay and qualifications of
Veterinary Asstt. in charge ...

3

Subordinate Establishment :—

(a) List of appointments and rate
of pay ...

(b) Whether present and Checked
with book ...

(c) Date up to which paid

(d) Complaints, if any ...

4

Condition, adequacy, suitability and
sanitary state (with any suggestions
for improvement) of—

(a) Buildings ... ...

(b) Enclosure, Latrines, Wells, &c

(c) Furniture ... ...