Emergency Shower and Eyewash Units Checklist.

• Audit Title

• Squadron

• Conducted on

  Date

• Inspector

• Location
  Address

• Supervisor

19.13. Emergency Shower and Eyewash Units Checklist

• Do supervisors ensure emergency showers and eyewash stations are provided, inspected, tested<br>and maintained IAW this standard? AFI 91-203 para. 19.3

  Yes

  No

  N/A

• Are hand-held drench hoses used only to supplement shower and eyewash units and not to replace them? AFI 91-203 para. 19.4.2

  Yes

  No

  N/A

• Are emergency shower and eyewash units in conspicuously identified accessible locations that do not require more than 10 seconds to reach? AFI 91-203 para. 19.5

  Yes

  No

  N/A

• Are emergency shower and eyewash units located so the water spray does not contact any electrical circuit? AFI 91-203 19.5

  Yes

  No

  N/A

• Are emergency showers installed in conjunction with, or in close proximity to, eye and face or eyewash facilities? AFI 91-203 para. 19.5

  Yes

  No

  N/A

• Are the units connected to a supply of water free from contamination and equal in purity to potable water? AFI 91-203 para. 19.6

  Yes

  No

  N/A

• Is the delivered water temperature in a comfortable range that would not discourage use of the unit? AFI 91-203 para. 19.6.1

  Yes

  No

  N/A

• Are self-contained units and the water supply lines of permanently-installed units protected from freezing and from sunlight or other heat sources that could cause extremes in water temperature? AFI 91-203 para. 19.6.1

  Yes

  No

  N/A

• Are permanently-installed and self-contained units installed in a fixed location identified with a highly visible sign and well lighted? AFI 91-203 para. 19.6.2

  Yes

  No

  N/A

• Where shutoff valves are installed on water supply lines to emergency shower and eyewash units, have signs or tags been installed to prevent accidental shutoff? AFI 91-203 para. 19.6.3

  Yes

  No

  N/A

• When actuated, does the water flow remain on without use of the operator‘s hands? AFI 91-203 para. 19.7.1

  Yes

  No

  N/A

• Is the control valve simple to operate (push-pull) and does it go from ―off‖ to ―on‖ in less than one second? AFI 91-203 para. 19.7.1

  Yes

  No

  N/A

• Is the actuating device (pull handle, walk-on treadle, or push handle) readily accessible and easily located? AFI 91-203 para. 19.7.2

  Yes

  No

  N/A

• If audible alarms or blinking lights are installed to show that the unit is in use, are they working properly? AFI 91-203 para. 19.8

  Yes

  No

  N/A

• Do supervisors ensure permanently installed shower and eyewash units are activated weekly to verify proper operation? AFI 91-203 para. 19.9.1

  Yes

  No

  N/A

• Are units installed in unoccupied or infrequently used areas tested prior to commencing any operations that could expose personnel to hazardous substances? AFI 91-203 para. 19.9.1

  Yes

  No

  N/A

• Do supervisors perform monthly inspection of permanently installed units IAW instructions in paragraph 19.12? AFI 91-203 para. 19.9.2

  Yes

  No

  N/A

• Are eyewash bottles maintained IAW the manufacturer‘s instructions? AFI 91-203 para. 19.9.4

  Yes

  No

  N/A

• Are workers whose duties expose them to conditions that may warrant the use of emergency equipment properly trained? AFI 91-203 para.19.10

  Yes

  No

  N/A

• When maintenance renders emergency shower or eyewash units inoperable, are adequate measures taken to safeguard employees? AFI 91-203 para. 19.11

  Yes

  No

  N/A

• Are emergency shower and eyewash actuating devices easy to locate and readily accessible to the user? AFI 91-203 para. 19.12.2.1.3

  Yes

  No

  N/A

• Is a means provided for eyewash units to ensure a controlled flow of potable water or its equivalent to both eyes simultaneously, at a pressure low enough not to be injurious to the user? AFI 91-203 para. 19.12.2.1.1

  Yes

  No

  N/A

• Is the stored fluid in self-contained units protected against contaminants and temperature extremes, and are instructions permanently affixed to the unit? AFI 91-203 para. 19.12.5

  Yes

  No

  N/A

• Have procedures been developed to prevent eyewash bottles from being exposed to extreme temperatures, and are the instructions and expiration dates permanently affixed to the unit? AFI 91-203 para. 19.12.6

  Yes

  No

  N/A

• Report Routing

• Supervisor Signature:

  Sign

• Notification

  Action

  Info

  N/A

• Superintendent Signature:

  Sign

• Notification

  Action

  Info

  N/A

• Commander Signature:

  Sign

• Notification

  Action

  Info

  N/A

• Safety Office Signature:

  Sign

• Notification

  Action

  Info

  N/A

• Wing Commander Signature:

  Sign

• Notification

  Action

  Info

  N/A