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(1401 <br /> EMERGENCY EYEWASH AND SAFETY SHOWER INSPECTIONS <br /> A. Eyewash and/or Shower Stations(i.e. plumbed units) <br /> Station ID# Weekly Flow Test (Initial) Accessible? Comments <br /> '• TQtAK Week 1 r Week 2 r Week 3 <br /> .fr•+ Week 4 Y Week 5' N <br /> TG•�►�h ( Week 1 Week 2 Week 3 <br /> A(�h Week 4—C Week 5 N <br /> (�hC 1Y' jar k Week 1_ :Neek 2 0" Week 3 <br /> fArM Week 4 Y Week5-- <br /> 5— / N <br /> Vdeek 1— WeeK 2— '.Neel.3 -- <br /> Week 4_ Week 5 _ <br /> "L.eek 1 Week 2 'Neek.:3 <br /> i -- — — Y/ N <br /> 'NeeK 4— Week 5 <br /> B. Portable Eyewash Units (i.e. solution filled units or saline eyewash units) <br /> Filled with Caps/Seals Expiration <br /> Unit ID# Accessible? Comments/Deficiencies <br /> Solution? I Intact? _ Date <br /> ShOP / N I /N- Y/ N '/4F,hi - - <br /> Wt�sh tea / N Cy-/ N CY--/ N ,J% �/ �✓1 <br /> e m <br /> 04T--1ti'.--NC !Y/ N /N N < r <br /> �i <br /> Y/ N Y/NY/ N ) p <br /> __ Z ` <br /> Y/ N + Y/N Y/ N ` <br /> I <br /> m <br /> Y/ N Y/NI Y/ N Tj <br /> Inspector's Name Inspector's Signature Date 2 <br /> Retail Facility Inspections Ver.1 <br />