文号:_________
第 页 共 页
被稽查单位或个人:_________________ 法定代表人/负责人:______________
地址:_____________________________ 联系电话 :______________________
稽查意见:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
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被稽查人或单位负责人签收: _________ 卫生监督机构盖章:_________
__________年__________月__________日 _______年_______月_______日
备注:本意见书一式三份,第一份存档,第二份交被稽查单位或个人,第三份交卫生行政机关
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