Title Page
PM PL01 - EWS - Safety Eye-Wash & Shower Inspection
PM PL01 - EWS - Safety Eye-Wash & Shower Inspection
Location
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Date
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Facility?
- POB - Port of Brisbane
- GCPH - Gold Coast Private Hospital
- QCH - Queensland Children's Hospital
- Scentre - Westfield Shopping Centre
- Ventia - State School
- CVSG - CV Services Group
- GCUH - Gold Coast University Hospital
- TDS - Tweed Day Surgery
- QPU - Queensland Police Union
- BAC01 - Brisbane Airport - ITB
- BAC02 - Brisbane Airport - DTB
- BACZZ - Brisbane Airport - Other
- MACG - McKenzie Aged Care Facility
- SCUH - Sunshine Coast University Hospital
- Spotless Defence - Amberley
- Spotless Defence - Enoggera
- Spotless Defence - Canungra
- Other
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POB Precinct
- Fisherman Island
- Port Gate
- Port West
- Hamilton
- Pinkenba
- Port North
- Colmslie
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QCH Facility
- QCH - Main Hospital
- CCHR - Children's Centre Health Research
- CHEP - Central Health Energy Plant
- FDN - Foundation Building
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Scentre Westfield - Facility?
- Coomera
- North Lakes
- Carindale
- Chermside
- Chermside CHO & ATO
- Helensvale
- Garden City
- Other
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Ventia State School - Facility?
- Coomera State School
- Murrumba State School
- Augusta State School
- Peregian State School
- Brightwater State School
- Bayview State School
- Woodlinks State School
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Building Name and Number or Room Name?
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Name of tradesperson
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Job Number
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Discipline?
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Preventative Maintenance (PM) Inspection Type
Asset
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Asset Particulars
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Asset ID Number (include photo of Asset label with number/bar code where applicable)?
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Asset Description?
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Size/Capacity
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Manufacturer?
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Model Number?
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Serial Number?
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Year asset/equipment was installed (approximate)?
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Inspect eyewash condition, check that all parts are in place and are in good condition, ensure that- • The shower valve and pull rod assembly are aligned for correct operation. • Shower head is present • No corrosion is evident on any components
- P6 - Excellent (No Priority - monitor >10 years)
- P5 - Good (Low Priority - monitor >4 years)
- P4 - Fair (Medium Priority - Consider action 2-4 years)
- P3 - Poor (High Priority - Consider action 1-2 years)
- P2 - Very Poor (Urgent - Consider action 0-12 months)
- P1 - Dangerous (Emergency - Consider action 48hrs/0-6 months)
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Ensure that there is unobstructed access to each unit.
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Operate the eye/face wash at full flow for one minute to flush supply line.
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Remove aerators and clean and debris lodged on the screen.
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Verify that the valves will activate from closed to fully open in one second or less.
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Verify that the water flow is not less than:<br>Showers- 75.7 l/min<br>Eye/Face Wash- 11.4 l/min<br>Eyewash- 1.5 l/min
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Verify that the water discharge pattern for each unit conforms to AS 4775.<br>Shower- minimum diameter of 508mm at 1524mm above floor level.<br>Eye/Face Wash and Eyewash - use test gauge complying with AS4775 to verify discharge pattern is acceptable.
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Verify that delivered water temperature is in the range of 15°-38°C.
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Ensure each unit is identified with a highly visible sign complying with AS 1319.
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Complete compliance tag attached to unit (company name and date of work)
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Overall Condition Rating?
- P6 - Excellent (No Priority - monitor >10 years)
- P5 - Good (Low Priority - monitor >4 years)
- P4 - Fair (Medium Priority - Consider action 2-4 years)
- P3 - Poor (High Priority - Consider action 1-2 years)
- P2 - Very Poor (Urgent - Consider action 0-12 months)
- P1 - Dangerous (Emergency - Consider action 48hrs/0-6 months)
Repairs
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Repairs and Repair Codes
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Select Repair Code Where Applicable Needed for Repair/Replacement of Asset
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Description of the defect with equipment/asset?
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Work (labour and materials) needed to rectify defect?
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Rectification due by (year)?
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Estimated budget replacement cost (whole number only - no 'k')?
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Take Photo (include photo of QR Code Asset Label)
