Twin Cities: 651.917.3075 • Milwaukee: 262.783.6040 • Green Bay: 920.687.8351 • Cleveland: 440.832.7700 177 Daily 4x Daily 4x Daily Daily Once per Week Once per Week if used Monthly Monthly As Indicated As Indicated As Indicated Monthly Pump Safety* Check(s) Completed (check box) Monthly Safety Equipment** Check Completed (check box) Backwashing completed when pressure indicates (check box) Fecal incidents recorded; Death, Illness, Injury Reported as required (check box) Corrective Actions Taken or Comments-brief (use back of sheet if needed)
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