478 lines
17 KiB
HTML
478 lines
17 KiB
HTML
<style>
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#sample {
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width: 80%;
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margin: 0 auto;
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background-color: white;
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font-family: Simsun;
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}
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input, label {
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vertical-align: top;
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}
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#sample table {
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width: 80%;
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margin: 50px auto;
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}
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#sample table td {
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border: 1px solid black;
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vertical-align: middle;
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padding: 8px;
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}
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#sample table caption p {
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font-size: 24px;
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font-weight: bold;
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}
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#sample table caption span {
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text-align: left;
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}
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#sample p {
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margin: 0;
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}
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#sample .p1 input {
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border: none;
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width: 10%;
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border-bottom: 1px solid black;
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padding-left: 5px;
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}
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#sample .p2 input {
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border: none;
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width: 80%;
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border-bottom: 1px solid black;
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}
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.wori {
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width: 100%;
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height: 100%;
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border: none;
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}
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.wocao {
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padding: 0px;
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}
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#sample tfoot p {
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font-size: 12px;
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text-align: left;
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padding-left: 10px;
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}
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</style>
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<div class="text-center" id="sample">
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<table class="table table-bordered">
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<caption>
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<p style="text-align:center;">上海市食品安全抽样检验抽样单</p>
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<span>抽样单编号：SHSPCJ</span>
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</caption>
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<thead>
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<tr>
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<td colspan="2" style="width:25%">任务来源</td>
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<td colspan="3" class="wocao" style="width:40%">
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<input type="text" class="wori" />
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</td>
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<td>任务类型</td>
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<td colspan="2" class="wocao" style="width:25%">
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<input type="checkbox" /><label>监督抽检</label>
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<input type="checkbox" />风险监测
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</td>
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</tr>
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<tr>
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<td rowspan="6" style="width:14%">被抽样人信息</td>
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<td>名称</td>
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<td colspan="3" class="wocao">
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<input type="text" class="wori" />
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</td>
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<td>区域类型</td>
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<td colspan="2">
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<input type="checkbox" />城市
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<input type="checkbox" />乡村
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<input type="checkbox" />景点
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</td>
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</tr>
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<tr>
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<td>地址</td>
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<td colspan="6">
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<p class="p1">
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<input type="text" />市<input type="text" />区（县）<input type="text" />街道（镇）<input type="text" />弄<input type="text" />号<input type="text" />室
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</p>
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<p class="p2"> <input type="text" /></p>
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</td>
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</tr>
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<tr>
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<td>法人代表</td>
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<td class="wocao">
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<input type="text" class="wori" />
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</td>
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<td>年销售额</td>
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<td class="wocao" style="width:12%">
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<input type="text" style="width:40%;height:100%;border:none;" />
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<span>万元</span>
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</td>
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<td colspan="2">营业执照号</td>
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<td class="wocao">
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<input type="text" class="wori" />
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</td>
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</tr>
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<tr>
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<td>联系人</td>
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<td colspan="2" class="wocao">
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<input type="text" class="wori" />
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</td>
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<td colspan="2">
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<input type="checkbox" />经营许可证
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</td>
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<td colspan="2">
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<input type="text" class="wori" />
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</td>
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</tr>
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<tr>
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<td>电话</td>
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<td colspan="2" class="wocao">
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<input type="text" class="wori" />
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</td>
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<td>传真</td>
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<td class="wocao" style="width:12%">
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<input type="text" class="wori" />
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</td>
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<td style="width:10%">邮编</td>
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<td class="wocao">
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<input type="text" class="wori" />
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</td>
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</tr>
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</thead>
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<tbody>
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<tr>
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<td>抽样地点</td>
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<td colspan="7" class="text-left">
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<p>
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<span>生产环节:</span>
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<input type="checkbox" /><label>原辅料库</label>
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<input type="checkbox" /><label>生产线</label>
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<input type="checkbox" /><label>半成品</label>
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<label>成品库</label>
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(<input type="checkbox" /><label>待检区</label>
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<input type="checkbox" /><label>已检区</label>)
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</p>
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<p>
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<span>流通环节:</span>
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<input type="checkbox" /><label>农贸市场</label>
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<input type="checkbox" /><label>菜市场</label>
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<input type="checkbox" /><label>批发市场</label>
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<input type="checkbox" /><label>商场</label>
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<input type="checkbox" /><label>超市</label>
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<input type="checkbox" /><label>小食杂店</label>
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<input type="checkbox" /><label>网购</label>
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<input type="checkbox" /><label>其他</label>(<input type="text" style="width:8%;border:none;border-bottom:1px solid black" />)
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</p>
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<p>
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<span>餐饮环节:</span>
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<span>餐馆</span>（
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<input type="checkbox" /><label>特大型餐馆</label>
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<input type="checkbox" /><label>大型餐馆</label>
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<input type="checkbox" /><label>中型餐馆</label>
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<input type="checkbox" /><label>小型餐馆</label>）<br />
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<span style="display:inline-block;margin-left:12%">食堂</span>（
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<input type="checkbox" /><label>机关食堂</label>
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<input type="checkbox" /><label>学校/托幼食堂</label>
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<input type="checkbox" /><label>企事业单位食堂</label>
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<input type="checkbox" /><label>建筑工地食堂</label>）<br />
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<input type="checkbox" style="margin-left:12%" /><label>小吃店</label>
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<input type="checkbox" /><label>快餐店</label>
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<input type="checkbox" /><label>饮品店</label>
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<input type="checkbox" /><label>集体用餐配送单位</label>
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<input type="checkbox" /><label>中央厨房</label>
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<input type="checkbox" /><label>其他</label>（<input type="text" style="width:7%;border:none;border-bottom:1px solid black" />） <br />
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<span>其 他:</span>
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<input type="text" style="width:60%;border:none;border-bottom:1px solid black" />
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</p>
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</td>
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</tr>
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<tr>
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<td rowspan="10">样品信息</td>
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<td colspan="2">样品来源</td>
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<td colspan="5">
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<input type="checkbox" /><label>加工/自制</label>
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<input type="checkbox" /><label>委托生产</label>
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<input type="checkbox" /><label>外购</label>
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<input type="checkbox" /><label>其他</label>
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</td>
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</tr>
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<tr>
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<td colspan="2">样品属性</td>
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<td colspan="5">
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<input type="checkbox" /><label>普通食品</label>
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<input type="checkbox" /><label>特殊膳食食品</label>
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<input type="checkbox" /><label>节令食品</label>
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<input type="checkbox" /><label>重大活动保障食品</label>
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<input type="checkbox" /><label>其他</label>
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</td>
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</tr>
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<tr>
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<td colspan="2"> 样品类型</td>
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<td colspan="5">
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<input type="checkbox" /><label>食用农产品</label>
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<input type="checkbox" /><label>工业加工食品</label>
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<input type="checkbox" /><label>餐饮加工食品</label>
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<input type="checkbox" /><label>食品添加剂</label><br />
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<input type="checkbox" /><label>食品相关产品</label>
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<input type="checkbox" /><label>其他</label>（<input type="text" style="width:20%;border:none;" />)
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</td>
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</tr>
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<tr>
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<td colspan="2"> 样品名称</td>
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<td colspan="2" class="wocao">
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<input type="text" class="wori" />
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</td>
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<td>商标</td>
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<td colspan="2" class="wocao">
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<input type="text" class="wori" />
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</td>
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</tr>
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<tr>
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<td colspan="2">
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<input type="checkbox" /><label>生产/</label>
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<input type="checkbox" /><label>加工</label><br />
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<input type="checkbox" /><label>购进日期</label>
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</td>
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<td colspan="2" class="wocao">
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<input type="date" style="width:80%;border:none;" />
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</td>
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<td>规格型号</td>
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<td colspan="2" class="wocao">
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<input type="text" class="wori" />
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</td>
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</tr>
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<tr>
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<td colspan="2"> 样品批号</td>
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<td colspan="2" class="wocao">
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<input type="text" class="wori" />
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</td>
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<td>保质期</td>
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<td colspan="2" class="wocao">
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<input type="text" class="wori" />
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</td>
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</tr>
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<tr>
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<td colspan="2"> 执行标准/技术文件</td>
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<td colspan="2" class="wocao">
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<input type="text" class="wori" />
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</td>
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<td>质量等级</td>
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<td colspan="2" class="wocao">
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<input type="text" class="wori" />
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</td>
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</tr>
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<tr>
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<td colspan="2">生产许可证编号</td>
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<td class="wocao">
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<input type="text" class="wori" />
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</td>
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<td>单价</td>
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<td class="wocao">
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<input type="text" class="wori" />
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</td>
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<td>是否出口</td>
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<td>
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<input type="checkbox" /><label>是</label>
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<input type="checkbox" /><label>否</label>
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</td>
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</tr>
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<tr>
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<td colspan="2">抽样基数/批量</td>
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<td class="wocao">
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<input type="text" class="wori" />
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</td>
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<td>抽样数量(含备样)</td>
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<td class="wocao">
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<input type="text" class="wori" />
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</td>
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<td>备样数量</td>
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<td class="wocao">
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<input type="text" class="wori" />
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</td>
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</tr>
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<tr>
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<td colspan="2">样品形态</td>
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<td colspan="2">
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<input type="checkbox" /><label>固态</label>
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<input type="checkbox" /><label>半固态</label>
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<input type="checkbox" /><label>液体</label><br />
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<input type="checkbox" /><label>气体</label>
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</td>
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<td>包装分类</td>
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<td colspan="2">
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<input type="checkbox" /><label>散装</label>
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<input type="checkbox" /><label>预包装</label>
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</td>
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</tr>
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<tr>
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<td rowspan="2">(标称)生产者信息</td>
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<td colspan="2">生产者名称</td>
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<td colspan="5" class="wocao">
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<input type="text" class="wori" />
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</td>
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</tr>
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<tr>
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<td colspan="2">生产者地址</td>
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<td colspan="3" class="wocao">
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<input type="text" class="wori" />
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</td>
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<td class="wocao">联系电话</td>
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<td><input type="text" class="wori" /></td>
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</tr>
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<tr>
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<td rowspan="2">(标称)样品储存条件</td>
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<td rowspan="2" colspan="3">
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<input type="checkbox" /><label>常温</label>
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<input type="checkbox" /><label>冷藏</label>
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<input type="checkbox" /><label>冷冻</label>
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<input type="checkbox" /><label>避光</label>
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<input type="checkbox" /><label>密闭</label>
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<input type="checkbox" /><label>其他</label>（<input type="text" style="width:30%;border:none;" />)
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</td>
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<td colspan="2">寄、送样品截止日期</td>
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<td colspan="2" class="wocao">
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<input type="date" class="wori" />
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</td>
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</tr>
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<tr>
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<td colspan="2">寄送样品地址</td>
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<td colspan="2" class="wocao">
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<input type="text" class="wori" />
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</td>
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</tr>
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<tr>
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<td>抽样样品包装</td>
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<td colspan="3">
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<input type="checkbox" /><label>玻璃瓶</label>
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<input type="checkbox" /><label>塑料瓶</label>
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<input type="checkbox" /><label>塑料袋</label>
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<input type="checkbox" /><label>无菌袋</label>
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<input type="checkbox" /><label>其他</label>（<input type="text" style="width:30%;border:none;" />)
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</td>
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<td colspan="2">抽样方式</td>
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<td colspan="2">
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<input type="checkbox" /><label>无菌抽样</label>
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<input type="checkbox" /><label>非无菌抽样</label>
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</td>
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</tr>
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<tr>
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<td rowspan="2">抽样单位信息</td>
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<td>单位名称</td>
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<td colspan="2" class="wocao">
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<input type="text" class="wori" />
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</td>
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<td>地址</td>
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<td colspan="3" class="wocao">
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<input type="text" class="wori" />
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</td>>
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</tr>
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<tr>
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<td>联系人</td>
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<td class="wocao">
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<input type="text" class="wori" />
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</td>
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<td class="wocao" style="padding:8px 0px;text-align:left;">
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<span>电话</span><input type="text" style="width:70%;border:none;" />
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</td>
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<td>传真</td>
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<td class="wocao">
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<input type="text" class="wori" />
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</td>
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<td>邮编</td>
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<td class="wocao">
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<input type="text" class="wori" />
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</td>
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</tr>
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<tr>
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<td>备注</td>
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<td colspan="7">（需要说明的其他问题）</td>
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</tr>
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</tbody>
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<tfoot>
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<tr>
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<td colspan="4">
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<p><strong>被抽样单位对抽样程序、过程、封样状态及上述内容无异议</strong></p>
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<p>被抽样单位签名（盖章）：<input type="text" style="width:20%;border:none" /></p>
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<p style="text-align:center "><input type="date" style="width:40%;border:none" /></p>
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</td>
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<td colspan="4">
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<p>抽样人（签名）：<input type="text" style="width:20%;border:none" /></p>
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<p>抽样单位（公章）：<input type="text" style="width:20%;border:none" /></p>
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<p style="text-align:center "><input type="date" style="width:40%;border:none" /></p>
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</td>
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</tr>
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</tfoot>
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</table>
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</div> |