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JIFFY LUBE MONTHLY HSSE CHECKLIST Date: <br /> Store Number: 1478 Performed By: Peter Gaines <br /> Fire Extinguisher Location/Numbers Pin Seal Present Pull Pin Present Hose and Nozzle Fully Charged? <br /> Questions: Yes No N/A Don't know <br /> Are all extinguishers ABC type? <br /> Is the extinguisher mounted between 3 and 5 feet above <br /> floor? <br /> Are all fire extinguishers directly accessible and clear of any <br /> obstructions? <br /> EYE WASH TYPE/LOCATION Yes No N/A Don't know <br /> Is there an eye wash station in the upper and lower bays? <br /> For each station, is the basin clean and intact ifplumbed? <br /> Water Clean/Unit Flushed? <br /> Water Streams"Cross"? <br /> Dust Caps Present? <br /> Are the hand-held eye wash units in good operating <br /> condition? <br /> Self-contained Units Operational and Maintained? <br /> COMMENTS/CORRECTIVE ACTIONS <br /> This checklist is not an exhaustive compilation of every hazard or risk associated with a store. For specific questions,contact your regional HSSE <br /> Coordinator. <br /> All Jiffy Lube Monthly HSSE Checklist deficiencies must be corrected. <br /> I have reviewed each item of this checklist,and to the best of my knowledge,the answers provided accurately describe the conditions of this <br /> location. <br /> Signature: DATE <br />