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EMERGENCY EYEWASH AND SAFETY SHOWER INSPECTIONS C.AIR.E. <br /> A. Eyewash and/or Shower Stations(i.e. plumbed units) <br /> Station ID# Weekly Flow Test (Initial) Accessible? y Comments <br /> Week 1 V" Week 2 V Week 3 <br /> — _ iY/ N <br /> wa�f ♦ V;ee!c 4_ Week 5- - <br /> Week 1 L % eek 2-� Week 3__- I �Y'/ N <br /> `A,eek 4._ Week 5 I `_- <br /> Week 1 ✓Week 2��Week 3_ / <br /> V ; (3;�� ;�ci lr.�t .%eek 4_ Week 5_ Y N <br /> Week 1 Week 2 Week 3 Y <br /> lkeek 4_ Week 5_ / N <br /> Week 1 Week2 Week 3 Y/ N <br /> .'week 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 /> f _ I Solution? Intact? Date <br /> / N Y/ N Y/ N / / �' 11 <br /> ✓1 & YN ,Y,/ N Y� N --- 90 <br /> off L "on <br /> - <br /> ✓�� I Y N Y /N JY N /� D <br /> Y Y Y <br /> -! Y/ N --f--- Y/ N — Y/ N Z = 4 <br /> Y Y Y D rn <br /> Inspector's Name Inspector's Signature Date <br /> Retail Facility Inspections Ver.1 <br />