custom safety shower form - justrite · custom safety shower form. note: ansi recommends 30 psi...

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© 2017 Justrite Mfg. Co. Code No. 165 (10/17) Don’t see what you need in Justrite’s line of readily available emergency equipment? Let our team design a custom solution to meet your specific requirements. As part of Justrite, Hughes Safety Showers group has more than 45 years of experience in meeting deadlines and design standards for any new build or site refurbishment project. They provide safety pre-sales consulting to ensure projects are completed smoothly, on schedule, and in compliance with ANSI. Offering expertise, advice, and technical support throughout all stages of your custom shower project, We empower you to make the best decisions for achieving your company’s safety goals. Describe what you are looking for in your safety shower, including quantity desired. If you have specifications, such as a Request for Quote (RFQ), Master Document Register (MDR), or Supplier Document Register (SDR), please submit along with this form. If you are unsure of what you need, please answer the questions in the next section to the best of your knowledge. I KNOW WHAT I WANT. Custom Safety Shower Form 1 of 3 WE’RE HAPPY TO HELP Please complete the questions on the following page. NOT SURE WHAT I NEED. Company Name Phone Email Name End User: Custom shower orders are non-cancelleable and non-returnable. Phone Email Name Account No. Company Name Distributor: REQUIRED INFORMATION: Sales/Rep Contact BDS Contact For Internal Use Only:

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Page 1: Custom Safety Shower Form - Justrite · Custom Safety Shower Form. Note: ANSI recommends 30 PSI minimum supply pressure. Supply pipe must be bigger than or equal to the water inlet

© 2

017

Just

rite

Mfg

. Co.

Cod

e N

o. 1

65 (

10/1

7)

Don’t see what you need in Justrite’s line of readily available emergency equipment? Let our team design a custom solution to meet your specific requirements. As part of Justrite, Hughes Safety Showers group has more than 45 years of experience in meeting deadlines and design standards for any new build or site refurbishment project. They provide safety pre-sales consulting to ensure projects are completed smoothly, on schedule, and in compliance with ANSI. Offering expertise, advice, and technical support throughout all stages of your custom shower project, We empower you to make the best decisions for achieving your company’s safety goals.

Describe what you are looking for in your safety shower, including quantity desired. If you have specifications, such as a Request for Quote (RFQ), Master Document Register (MDR), or Supplier Document Register (SDR), please submit along with this form. If you are unsure of what you need, please answer the questions in the next section to the best of your knowledge.

I KNOW WHAT I WANT.

Custom Safety Shower Form

1 of 3

WE’RE HAPPY TO HELPPlease complete the questions on the following page.

NOT SURE WHAT I NEED.

Company Name

Phone

Email

Name

End User:

Custom shower orders are non-cancelleable and non-returnable.

Phone

Email

Name

Account No.

Company Name

Distributor:REQUIRED INFORMATION:

Sales/Rep Contact

BDS Contact

For Internal Use Only:

Page 2: Custom Safety Shower Form - Justrite · Custom Safety Shower Form. Note: ANSI recommends 30 PSI minimum supply pressure. Supply pipe must be bigger than or equal to the water inlet

Distributor Name: End User Name:

Answer as many questions as you can so we can begin our discussions.HELP ME DETERMINE THE BEST PRODUCT FOR MY APPLICATION.

Is there a drain near the location of the shower to route spent water? o Yes o No

1. CLIMATE

2. AVAILABILITY OF WATER

What is the ambient temperature of the location where the shower will be installed? Choose from climate/locations below:

ANSI requires water delivered by emergency safety equipment should be tepid, between 60-100°F (16-38°C).What best describes your condition(s)?

o Applications not subject to freezing or overheating

o Applications subject to freezing, 32°F (0°C) or below

o Applications subject to overheating, 100°F (38°C) or above

o Unsure or other

o Plumbed in, unheated water source is available

o Plumbed in, heated water source is available

o Water supply is not available

o Water source is available but supply pressure is inconsistent or weak

o Unsure or other

2 of 3

Custom Safety Shower Form

Note: ANSI recommends 30 PSI minimum supply pressure. Supply pipe must be bigger than or equal to the water inlet on equipment, otherwise the water flow will be inadequate.

o Alarm package o Integrated drain sump o Walk on foot-panel operation

o Strip screens o Doors o GRP paneling

o Sun shields o Water treatment module o Chiller unit

o Lighted sign box o Immersion heater o Unsure which options are needed

3. COMMON TANK SHOWER CUSTOMIZATION OPTIONS (Ask about others)

o 120V o 240V o 480V

o 50Hz o 60Hz

4. ELECTRICAL VOLTAGE REQUIREMENTS (If applicable)

What are the voltage requirements for your application?

What are the Hertz requirements?

Page 3: Custom Safety Shower Form - Justrite · Custom Safety Shower Form. Note: ANSI recommends 30 PSI minimum supply pressure. Supply pipe must be bigger than or equal to the water inlet

o ANSI Z358.1-2014 o OSHA 1910.151 o EN15154 o Unsure

7. COMPLIANCE REQUIREMENTS

Click Here to submit via email to Justrite business development

Fax: 1-800-488-5877 Email: [email protected]

(“Click Here” button will prompt you to choose email preference)

3 of 3

5. ELECTRICAL AREA CLASSIFICATION (Where applicable)

Does the area where the shower will be located have specific risks, i.e. gases or materials that can combust if thereis a spark from electrical equipment? What is your electrical area classification?

o Class 1 Division 2

o General Purpose

o Unsure or other

o Special water inlet requirements

o Special instrumentation requirements

o Tagging and nameplate requirements

o Special drain requirements

6. OTHER CUSTOM OPTIONS

Custom Safety Shower Form