Title Page
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Conducted on
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Prepared by
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Facility Name
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Campus
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SPD Location
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Campus
- Bellevue
- Elmhurst
- Harlem
- Jacobi
- Kings
- Lincoln
- Metropolitan
- North Central Bronx
- Queens
- South Brooklyn - Coney
- Woodhull
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Campus
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SPD Location
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SPD Location
Washer Test Audit
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Date of Washer Test
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Test Type
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Test LOT Number
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Washer Number
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Washer Type
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Rack Upper Level Results
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Rack Middle Level Results
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Rack Lower Level Results
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Top Left Corner Result
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Bottom Left Corner Results
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Middle Results
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Top Right Corner Results
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Bottom Right Corner Results
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Results Read and Interpreted By: Technician