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S <br /> Simplot EMERGENCY EYEWASH AND SAFETY SHOWER INSPECTIONS cua.Fi.i�. <br /> A . Eyewash and/or Shower Stations (i. e. plumbed units) <br /> Station ID# Weekly Flow Test ( Initial) Accessible ? Comments <br /> � f Week V Week i% Week 3 _ � , <br /> y � Fit 3 Week 4 _ Week 5 _ <br /> Week 1 V Week 2 V Week 3 — � •,/ <br /> �4�0 i +'� Week (t YJJ <br /> �'�; Week4 5 <br /> .� Week 1 Week 2 Week 3 _ r' <br /> A `�� avLPT Neek4 _ Week5 _ N <br /> Week 1 _ Week 2 _ Week 3 _ Y / <br /> Week Week 5 <br /> Week 1 _ Week 2 Week 3 _ Y / <br /> Week 4 Week 5 <br /> B. Portable Eyewash Units (i. e. solution filled units orsaline eyewash units) <br /> Filled with I Caps/Seals Expiration <br /> Unit ID# Solution ? Intact? Accessible ? Date Comments/Deficiencies <br /> / <br /> 0a, 7 I <br /> Ly (Til N DD <br /> OO )t10 Y N V. / N Y N n ' , <br /> Zd <br /> Y / N Y / N Y / N 2: ' . <br /> Y / N Y / N Y / N <br /> Y / N Y / N Y / N > <br /> J. ,r �1 D ��If r7y ��-o F7 <br /> Inspector' s Name Inspector's Signature Date <br /> Retail Facility Inspections Ver. 1 <br />