Title Page
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Site conducted
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Conducted on
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Prepared by
EGMS Portable eye wash monthly checklist
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Does the station have a minimum of 1L of eyewash solution ?
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Is the expiration date on any eyewash bottles within the expiration period?
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Are the station and bottles free from dust and dirt ?
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Are the eyewash bottles intact with unbroken seals?
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Is the station well-lit and signposted and free from obstruction?
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Is the station able to securely hold the eyewash bottles?
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Comments/Actions Needed
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Inspector Signature