Lab HQ

Emergency Equipment Maintenance Log

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Title Page

Site conducted
Conducted on
Prepared by

Inspection for Emergency Shower/Eyewash Station for for damage
Flushing the Eyewash Station for 10 seconds
Flushing the Emergency Shower for 10 seconds and clean the area of the water spill
Is the flow of water adequate? (Do not conduct test on portable units)
Is the expiration date on any eyewash bottles within the expiration period?
Ensure the phlebotomy Chair is functioning
Press patient distress button for 2 seconds and disable it in the Lab technical specialist room
Comments/Actions Needed
Inspector Signature

Lab HQ

Emergency Equipment Maintenance Log

Use this Template

Print as PDF

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