710-FRM-0144 Monthly Eyewash Station Inspection

• Document No.710-FRM-0144 rev 3 / April 25, 2016

• Monthly Eye Wash stations audit

• Conducted on

  Date

• Montgomery, PA plant

• Kingsport, TN plant

• Phoenix, AZ plant

• Prepared by

Each eyewash station is to be allowed to run for at least two minutes activating water flow by depressing the eyewash control.

• Is the eyewash identified by a highly visible sign?

  Yes

  No

  N/A

• Is the area surrounding the eyewash station free of all obstructions?

  Yes

  No

  N/A

• Is the unit free from sharp projections in the operating area of the unit?

  Yes

  No

  N/A

• Is the eyewash station easily activated?

  Yes

  No

  N/A

• Are the nozzles equipped with protective covers?

  Yes

  No

  N/A

• Are the covers removed by activation of the eyewash station?

  Yes

  No

  N/A

• Is the water flowing from both eye pieces?

  Yes

  No

  N/A

• Is the flow of water of equal height?

  Yes

  No

  N/A

• Is the flow of water of clear?

  Yes

  No

  N/A

• If not initially clear, if after running for two minutes does it become clear?

  Yes

  No

  N/A

• Does the spray pattern deliver a steady stream of water or is the flow further divided?

  Yes

  No

  N/A

• Does the flow continue until the mechanism is returned to its resting position?

  Yes

  No

  N/A

• Does the water drain from the bowl/sink?

  Yes

  No

  N/A

• Any other concerns?

  Yes

  No

  N/A

• All Eye Wash stations verified?

  Yes

  No

  N/A

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