Title Page
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Document No.
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Flushing of Infrequently Used Outlets Weekly Checks
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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CH2 Ladies Old Boot Wash Sink Nr Fire Exit Tested OK
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Comments
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CH2 First Aid Room Code 2367 Tested OK
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Comments
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CH2 Disabled Toilet WHB Tested OK
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Comments
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CH2 Disabled Toilet WC Tested OK
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Comments
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Incubator Room Tested OK
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Comments
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Seamer Workshop Tested OK
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Comments
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Outside Pots and Pouch Opp Legards Hot and Cold Tested OK
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Comments
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Archive Room Tested OK
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Comments
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Energy Centre Sink Tested OK
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Comments
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Date and Time
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Signature