Title Page

  • Conducted on

  • Inspected by

  • Company/Site name

  • Location

Eyewash Station Inspection

Visual Inspection

  • Capture and upload media documentation of findings/results as applicable.

  • Is the eyewash station clearly labeled with appropriate signage and instructions for use?

  • Is the path to the eyewash station well-lit, clear of obstacles, and located within the required proximity to potential hazard areas?

  • Is the eyewash station clearly visible and demarcated?

  • Are there any electrical connections close to the eyewash or eyewash station?

  • Does the station have all parts/not broken?

  • Is there a bucket located under the eyewash to collect runoff?

  • Are the eyewash nozzles free from clogs, debris, or any signs of damage?

  • Are caps damaged, need to be replaced, or need to be cleaned due to dirt and debris?

Activation Test

  • Activate eyewash station to check for appropriate flow. Flush the eyewash for at least 30 seconds.

  • Does the eyewash station operate properly?

  • Are the jets working properly?

  • Is there a steady flow of water from both eye pieces?

  • 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).

  • Is the water clear?

  • Do the caps open (pop off) without assistance when fully activated? If not, this is an indication of low flow.

  • 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).

  • Is the plumbing free from leakage?

  • 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

  • Ensure all recommended corrective actions are appropriately assigned and endorsed before signing and completing the report.

  • Other Notes and Comments

  • Inspector Name and Signature

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