Eye Wash Inspection

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Yes

  No

  N/A
Sheet1

• Year : 2022

• Eye Wash Station #1-6

  Yes

  No

  N/A
Week

• Date

  Date

• The eye wash station is free of obstruction

  Yes

  No

  N/A

• The eye wash is easily activated

  Yes

  No

  N/A

• The nozzles are equipped with protective covers

  Yes

  No

  N/A

• The covers are removed by eyewash activation

  Yes

  No

  N/A

• The water is flowing from both eyepieces

  Yes

  No

  N/A

• The flow of water is equal height

  Yes

  No

  N/A

• The flow of water is clear after fluching

  Yes

  No

  N/A

• Initials

  Compliant

  Non-Compliant

  N/A

undefined

• Yes

  No

  N/A
Week

• Date

  Date

• The eye wash station is free of obstruction

  Yes

  No

  N/A

• The eye wash is easily activated

  Yes

  No

  N/A

• The nozzles are equipped with protective covers

  Yes

  No

  N/A

• The covers are removed by eyewash activation

  Yes

  No

  N/A

• The water is flowing from both eyepieces

  Yes

  No

  N/A

• The flow of water is equal height

  Yes

  No

  N/A

• The flow of water is clear after fluching

  Yes

  No

  N/A

• Initials

  Yes

  No

  N/A
Week

• Date

  Date

• The eye wash station is free of obstruction

  Yes

  No

  N/A

• The eye wash is easily activated

  Yes

  No

  N/A

• The nozzles are equipped with protective covers

  Yes

  No

  N/A

• The covers are removed by eyewash activation

  Yes

  No

  N/A

• The water is flowing from both eyepieces

  Yes

  No

  N/A

• The flow of water is equal height

  Yes

  No

  N/A

• The flow of water is clear after fluching

  Yes

  No

  N/A

• Initials

  Yes

  No

  N/A
Sheet2

• Year: 2022

  Yes

  No

  N/A

• Date

  Date

• Initials

  Yes

  No

  N/A

• Week 9:

• Week 22:

• Week 35:

• Week 48:

• Yes

  No

  N/A