EMERGENCY EYEWASH/SHOWER
WEEKLY
TESTING SCHEDULE
 

 
Supervisor/Instructor ___________________________________________
Department: _______________________ Lab/Room# __________________ Location ____________
     
Shower or Eyewash Date Tested Tested By 
 
 
   
 
 
   
 
 
   
 
 
   
 
 
   
 
 
   
 
 
   
 
 
   
 
 
   
 
 
   
 
 
   
 
 
   
 
 
   
Note: Completed forms must be retained no less than three (3) years.