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Example Data Collection form for Water Softeners, Carbon Filters and Safety Showers/Eye Wash

System/Locatin

Date/Time Started

Date/Time Finished

Water Softener - kitchen Carbon Filter – kitchen

6/15/20 - 9:00 AM 6/15/20 – 11:00 AM

6/15/20 – 11:10 AM

6/15/20 – 11:40 AM

Safety shower - mechanical room 624 Eye wash mechanical rom 624

6/15/20 – 1:00 PM 6/15/20 – 1:15 pm

6/15/20 1:15 PM

6/15/20 1:20 PM

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