Download the form
The first file is the form itself, the Whirlpool Foot Spa Cleaning Record (BAC-FI-004-E), the page a TDLR inspector expects to see on a clipboard next to each pedicure chair. It is the record page from TDLR’s own PDF with nothing changed; TDLR’s version adds an instruction sheet in front of it, which you do not need to print every time. The second file is the same form filled in for one basin, so you can check your own pages against a correct one. Some salons keep the record in Spanish: TDLR publishes the identical form as BAC-FI-004-S.
How to print it so it fits
The form is designed for letter paper turned sideways. Three print settings matter, and the defaults get two of them wrong:
- Paper: Letter, 8.5 by 11. Legal or A4 shifts the grid and the last rows land in the margin.
- Orientation: landscape. Portrait shrinks the eighteen rows to a strip nobody can write in.
- Scale: 100 percent, or “Actual size”. Not “Fit to page”, which some printers use to add a margin and shrink the boxes.
Plain paper and black ink are fine. Print one page per chair to start, put each on its own clipboard or in a sleeve at the chair, and keep a pen with it. A record that lives at the basin gets filled in; one that lives at the front desk gets filled in at closing, from memory.
Filling in the header
The top of the form asks for four things. Fill them in before the page goes out to the floor, because every page for the same chair needs the same header:
| Field on the form | What goes there |
|---|---|
| Establishment or School Name | The salon’s name as it appears on the establishment license, not the sign out front if they differ. |
| Establishment or School License Number | The salon’s establishment license number. Not a technician’s license; those go in the rows. |
| Establishment or School Address | The street address on the license. |
| Basin/Tub Number | The chair this page belongs to. Number every chair once, keep the numbers, and start a fresh page under the same number when one fills. |
A filled example, row by row
This is the filled example from the download, rendered on the page. Eighteen rows for basin 1 over about two weeks, with the WHO column written the way shops write it, name and license number together.
p.m.FULL NAME(Please Print)Not UsedPortable
Jet Used &
CleanedAfter Each
ClientEnd of DayBi-Weekly
Four of those rows cover every situation the form has a box for:
| Row | What happened | Boxes checked |
|---|---|---|
| 1 | 07/25, 2:56 PM, Hang Nguyen: a client finished, the basin was drained, scrubbed and disinfected. | Portable Jet Used & Cleaned, After Each Client |
| 4 | 07/25, 6:31 PM, Kim Le: the same routine, on the night the two-week deep clean also ran. | Portable Jet Used & Cleaned, After Each Client, Bi-Weekly |
| 7 | 07/25, 10:26 PM, Mai Tran: closing, the chemical flush on a basin that had clients that day. | End of Day, and nothing else |
| 12 | 07/28, 7:34 AM, Kevin: the basin was not used that day, and the day still gets a row. | Not Used, and nothing else |
Notice that the End of Day row stands alone. It is a separate procedure at a separate time, so it never shares a row with the last client of the day. The combinations that fail an inspection, and the ones that pass, are laid out in our guide to filling out the BAC-FI-004-E.
How many pages you will go through
A page holds eighteen rows, and every cleaning is a row: each client, the end-of-day flush, the idle days, the two-week deep clean. A busy chair produces about five rows a day once the closing row is counted, so a page lasts three and a half days and the sixty days you have to keep runs to seventeen pages per chair. A quiet chair at two rows a day uses about seven.
| Chairs | Busy, 5 rows a day | Quiet, 2 rows a day |
|---|---|---|
| 1 chair | 17 pages | 7 pages |
| 5 chairs | 85 pages | 35 pages |
| 10 chairs | 170 pages | 70 pages |
| 16 chairs | 272 pages | 112 pages |
| 25 chairs | 425 pages | 175 pages |
The pages are cheap. What they cost is the pulling: an inspector asks for one chair and one date range, and the answer has to come out of that stack, in order, with no row missing. Keep the filled pages by chair, newest on top, and do not throw the old ones out on day sixty-one; a few extra weeks of history has never hurt anyone at an inspection.
Keep printing, or stop
Paper meets the rule. What it does not do is fill itself in: the row gets written by whoever is still there at close, from memory, and the gap an inspector finds is usually a closing flush that happened and was never written down. ReadyPedi asks the technician for the same boxes at the chair, stamps this exact form, and prints the sixty days for any chair on the spot. If you stay on paper, print from this page and keep the filled example nearby.
Frequently asked questions
Is this the official TDLR form?
Yes. It is the record page of TDLR form BAC-FI-004-E, unchanged. TDLR publishes it as a two-page PDF whose first page is instructions; this download is the record page on its own, so it prints as one landscape sheet. TDLR’s full PDF is linked above and in the sources.
Is there a Spanish version of the form?
Yes. TDLR publishes the same form in Spanish as BAC-FI-004-S, linked in the sources. The columns and boxes are identical, so a sheet kept in Spanish is the same record to an inspector.
Can I fill the PDF in on a computer?
No. It is a flat PDF, not a fillable one. Print it and write on it, or use a log that stamps the form for you, which is what ReadyPedi does.
Do I need a separate record for every chair?
Yes. TDLR’s instructions say to keep a separate record for each whirlpool foot spa or chair. Number your chairs once, write the number in the Basin/Tub Number box, and start a fresh page under the same number when one fills.
How many pages will one chair use?
A page holds eighteen rows. At five entries a day, which is what a busy chair produces once the end-of-day row is counted, a page lasts about three and a half days and a chair goes through about seventeen pages in sixty days. A quiet chair at two entries a day uses about seven.
Can I use a log book from Amazon or my own template instead?
The rule is about the record's content, not this exact layout, but inspectors know this form and its five boxes, and a bought log book often lacks them or has different ones. Using the official form removes the conversation.
How long do I keep the filled pages?
At least sixty days, and available on request from a client or a TDLR representative. Keep them in the salon, in order, by chair.
This page offers the BAC-FI-004-E form for convenience and is not legal advice. TDLR’s rules and TDLR’s own publication of the form are the authority on Texas foot-spa cleaning and recordkeeping requirements.