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

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.