APPENDIX 321 



This is to certify that, on the dates below indicated, official 



visits were made to the dairy, owned and conducted by 



of (indicating town and state), where careful 



inspections of the dairy employees were made. 



(a) Number and dates of visits since last report. >. 



(&) Number of men employed on the plant. . 



(c) Has a recent epidemic of contagion occurred near the 

 dairy, and what was its nature and extent? . 



(d) Have any cases of contagious or infectious disease 

 occurred among the men since the last report? . 



(e) Disposition of such cases. . 



(/) What individual sickness has occurred among the men 



since the last report? . 



(g) Disposition of such cases. . 



(h) Number of employees now quarantined! for sickness. 



(i) Describe the personal hygiene of the men employed for 

 milking when prepared for and during the process of milking. 



0) What facilities are provided for sickness in employees? 



(Ar) General hygienic condition of the dormitories or houses 

 of the employees. . 



(I) Suggestions for improvement. . 



(m) What is the hygienic condition of the employees and 

 their surroundings? . 



(n) How many employees were examined at each of the 

 foregoing visits? . 



(o) Remarks. 



Attending Physician. 

 Date, . 



