Title Page
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Conducted on
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Inspected by
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Company/Site name
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Location
Eyewash Station Inspection
Visual Inspection
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Capture and upload media documentation of findings/results as applicable.
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Is the eyewash station clearly labeled with appropriate signage and instructions for use?
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Is the path to the eyewash station well-lit, clear of obstacles, and located within the required proximity to potential hazard areas?
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Is the eyewash station clearly visible and demarcated?
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Are there any electrical connections close to the eyewash or eyewash station?
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Does the station have all parts/not broken?
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Is there a bucket located under the eyewash to collect runoff?
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Are the eyewash nozzles free from clogs, debris, or any signs of damage?
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Are caps damaged, need to be replaced, or need to be cleaned due to dirt and debris?
Activation Test
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Activate eyewash station to check for appropriate flow. Flush the eyewash for at least 30 seconds.
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Does the eyewash station operate properly?
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Are the jets working properly?
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Is there a steady flow of water from both eye pieces?
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If the flushing fluid is water, the water in the eyewash station shall be potable (drinkable) and kept at a tepid temperature not exceeding 38 degrees C (100 degrees F).
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Is the water clear?
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Do the caps open (pop off) without assistance when fully activated? If not, this is an indication of low flow.
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Can the unit be activated without having to hold on (hands-free) and adjust the flow? Check that sufficient flushing height is provided (e.g., flow not trickling out).
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Is the plumbing free from leakage?
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Promptly clean up any water that is spilled on the floor as a result of the inspection process. Any water collected can be emptied at the most convenient location such as a sink, custodial floor sink, or a floor drain.
Completion
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Ensure all recommended corrective actions are appropriately assigned and endorsed before signing and completing the report.
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Other Notes and Comments
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Inspector Name and Signature
