Eye Wash Station Monthly Audit Checklist

• Site conducted

  Select

• EYE WASH LOCATION:

• Conducted on

  Date

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is the eyewash station clearly visible and demarcated?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Does the station have all parts in tact?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Does the eyewash station operate properly?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is the water clear?

  Yes

  No

  N/A

Completion

• Conducted By:

• Date & Time Completed

  Date

• Signature

  Sign