Title Page
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Conducted on
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Prepared by
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Location
Eye Wash Station Inspection
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Equipment installed within 10 seconds from the hazard and on the same plane as the hazard
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Pathway is clear of obstructions
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Plumbed equipment should be activated to ensure compliant operation and to clear any sediment. If plumbed, mark yes after you have run the equipment for 10 seconds minimum.
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Self-contained equipment should be checked to determine if the flushing fluid needs to be changed or supplemented. Mark yes if the fluid is still within the date period and is full.
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Equipment free of broken or missing parts?
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Equipment protected against freezing?
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Equipment is clean and free of dirt, dust and debris?
