Sin Yong Ooi

RIM Emergency Shower & Eye wash checklist

Quarterly internal inspection

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Title Page

Branch:
Conducted on
Prepared by

No obstruction around and reachable within 10 seconds from store
Visual Inspection: No sign of water leaking from pipe
Visual Inspection: No sign of water blockage from drainage
Visual inspection: Spray heads and Collection Bowl are free from foreign object/ contaminants
Push actuator pedal activate eyewash: Water flow pressure good (reachable to 2 eyes simultaneously)
Turn tap activate shower: Water flow pressure good (cover whole body)
Snap a photo of the unit:
Signature of Inspector:

Reference

Reference for parts name

Sin Yong Ooi

RIM Emergency Shower & Eye wash checklist

Quarterly internal inspection

Use this Template

Print as PDF

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