Title Page

  • Audit No.

  • Customer Details: The University of Qld

Audit Details

  • Safety Shower/Emergency Eyewash Location
  • Building Name and Number

  • Floor Level

  • Room Number

  • SS/EYE WASH Identification number

  • Add a photo of the ID Plate

  • Add a photo of Installation

  • Conducted on

  • Conducted by

  • Name

Safety Showers

  • Is the Safety Shower hard plumbed to water supply?

  • Discontinue audit

  • Is Access to the Safety Shower inhibited?

  • Report to Supervisor

  • Add photo

  • Is the pathway through the Lab to the Safety Shower inhibited?

  • Report to Supervisor

  • Add photo

  • Is the Safety Shower outlet height, between 2083 mm & 2438mm?

  • Report to Supervisor

  • Record height

  • Add photo

  • Record height

  • Is the flow rate above the minimum 75.7 L/min?

  • Report to Supervisor

  • Record flow rate

  • Add photo

  • Record flow rate

  • Add photo

  • Is there a minimum of 406mm from the centre of the Safety Shower which is free from obstruction?

  • Report to Supervisor

  • Detail obstruction

  • Add photo

  • Does the Control Valve remain open without the use of your hands?

  • Report to Supervisor

  • Give details

  • Is the Safety Shower in an enclosure?

  • Give details & confirm that there is 864mm diameter of unobstructed area around centre of SS

  • Add photo

  • Can this or any other Safety Shower be accessed from anywhere in the Lab in 10 seconds?

  • Detail issues

  • Add photo

  • Are Safety Shower locations clearly marked & visible through the entire Lab?

  • Give details

  • Add photo

  • Is the water from the Safety Shower tepid (i.e. between 15.6’c -37.8’c)?

  • Report to supervisor

  • Record temperature

  • Add photo

  • Record temperature

  • Can you activate shower & measure spray pattern for Compliance with Figure 6.1 from AS4775

  • Give details

  • Add photo

Emergency Eyewash

  • Is the Eyewash hard plumbed?

  • Discontinue audit and report to supervisor

  • Is the access to the Eyewash inhibited?

  • Report to supervisor

  • Add a photo

  • Is the pathway through the Lab to the Eyewash inhibited?

  • Report to supervisor

  • Add a photo

  • Does the Eyewash have protection from airborne contaminants?

  • Do they remove without a separate motion to the operation of the Eyewash

  • Report to supervisor

  • Give details

  • Add a photo

  • Is the Eyewash Unit hands free once operated?

  • Report to supervisor

  • Give details

  • Add a photo

  • Is the Eyewash Unit positioned with outlet nozzles between 838mm and 1143mm?

  • Report to supervisor

  • Give details

  • Add a photo

  • Is the Eyewash Unit positioned with outlet nozzles having a minimum 153mm clearance from any wall or obstruction?

  • Report to supervisor

  • Give details

  • Add a photo

  • Is the Eyewash Unit flow rate above 1.5L/M @ 210 kpa when measured with flow meter?

  • Report to supervisor

  • Record flow rate

  • Add a photo

  • Record flow rate

  • Add a photo

  • Does the Eyewash Unit flushing fluid cover the test gauge as described in AS4775?

  • Report to supervisor

  • Give details

  • Add a photo

  • Is the water from the Eyewash Unit tepid (i.e. between 15.6’c – 37.8’c)?

  • Report to supervisor

  • Record temperature

  • Add a photo

  • Record temperature

  • Add a photo

Eye/Face Wash

  • Is the Eye/Face Wash hard plumbed?

  • Discontinue audit and report to supervisor

  • Is the access to the Eye/Face Wash inhibited?

  • Report to supervisor

  • Add photo

  • Is the pathway through the Lab to the Eye/Face Wash inhibited?

  • Report to supervisor

  • Add photo

  • Does the Eye/Face Wash have protection from airborne contaniments?

  • Report to supervisor

  • Give details

  • Add photo

  • Do they remove without a separate motion to the operation of the Eye/Face Wash?

  • Is the Eye/Face Wash Unit hands free once operated?

  • Report to supervisor

  • Give details

  • Add photo

  • Is the Eye/Face Wash Unit positioned with outlet nozzles between 838mm and 1143mm?

  • Report to supervisor

  • Give details

  • Add photo

  • Is the Eye/Face Wash Unit positioned with outlet nozzles having a minimum 153mm clearance from any wall or obstruction?

  • Report to supervisor

  • Give details

  • Add photo

  • Is the Eye/Face Wash Unit flow rate above 11.4 L/M @ 210 Kpa when measured with flow meter?

  • Report to supervisor

  • Record flow rate

  • Add photo

  • Record flow rate

  • Add photo

  • Does the Eye/Face Wash Unit flushing fluid cover the test gauge as described in AS4775?

  • Report to supervisor

  • Give details

  • Add photo

  • Add photo

  • Does the Control Valve remain open without the use of your hands?

  • Report to supervisor

  • Give details

  • Add photo

  • Is the water from the Eye/Face Wash Unit tepid (i.e. between 15.6’c – 37.8’c)?

  • Report to supervisor

  • Record temperature

  • Add photo

  • Record temperature

  • Add photo

Sign Off

  • Name of Person

  • Person's Name

  • Sign here

  • Compliant or non-compliant

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.