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Sul, °• [i EMERGENCY EYEWASH AND SAFETY SHOWER INSPECTIONS GARS <br /> A. Eyewash and/or Shower Stations(i.e. plumbed units) <br /> Station ID# Weekly Flow Test (Initial) Accessible? Comments <br /> Its-;-. 't,1a I !"leek 1 -Neel;2 ✓Week 3 vo!�' CIN N <br /> ---Week 4,, Week 5 - <br /> F, 'fqn IL I %leek 1 l\`eel;2 y,<-CJeek 3 <br /> Week 4 eek 5— (Y <br /> Gle 1, An k Vdeek 1 Week 2 j/`,Neek 3 ✓ N <br /> ��^a `vVeek 4 y/bVeek 5 <br /> Week 1. _ 'Neek 2_ Week 3_ <br /> Week 4 Wee,;5 Y N <br /> / <br /> Week 1__ Week 2 .Neek 3_ Y/ N <br /> I vVeek 4 Week 5_ <br /> B. Portable Eyewash Units (i.e. solution filled units or saline eyewash units) <br /> TFilled with Caps/Seals Expiration <br /> Unit ID# Accessible? i Comments/Deficiencies <br /> Solution? Intact? Date <br /> - - ` P N � /N I (7)/ N <br /> n� Z <br /> -- (Y)/ N cd n/ N m <br /> z <br /> JU <br /> / N N (V/ N ITI <br /> J O <br /> Y/ N Y/N Y/ N D Y <br /> Y/ N Y/ iJ Y/ N <br /> Y/ N Y/ PJ I Y/ N Z = o <br /> D <br /> �a:u- Mr-A r�C � i� IJ- zo 07 r1 <br /> Inspector's Name Inspector's Signature Date y <br /> Retail Facility Inspections Ver.1 <br /> EMERGENCY <br /> EYEWASH <br />