Cerise Weekly Eyewash Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Tube bend shop (gravity)

• Is the area clear of obstructions?

  Yes

  No

  N/A

• Is the solution within 6 months of mixing date?

  Yes

  No

  N/A

• Are the straps tightly secured?

  Yes

  No

  N/A

Tube Bend Shop (bottle)

• Are bottles readily available and unopened?

  Yes

  No

  N/A

Clean Line

• Are bottles readily available and unopened?

  Yes

  No

  N/A

Sub Assembly- Mezzanine

• Are bottles readily available and unopened?

  Yes

  No

  N/A

Flammable Fill Station

• Are bottles readily available and unopened?

  Yes

  No

  N/A

Notes

• Add signature

  Sign