Title Page

  • Document No.

  • Flushing of Infrequently Used Outlets Weekly Checks

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • CH2 Ladies Old Boot Wash Sink Nr Fire Exit Tested OK

  • Comments

  • CH2 First Aid Room Code 2367 Tested OK

  • Comments

  • CH2 Disabled Toilet WHB Tested OK

  • Comments

  • CH2 Disabled Toilet WC Tested OK

  • Comments

  • Incubator Room Tested OK

  • Comments

  • Seamer Workshop Tested OK

  • Comments

  • Outside Pots and Pouch Opp Legards Hot and Cold Tested OK

  • Comments

  • Archive Room Tested OK

  • Comments

  • Energy Centre Sink Tested OK

  • Comments

  • Date and Time

  • Signature

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