Title Page

  • Conducted on

  • Prepared by

Emergency Eyewash Station #1 (Prebatch Whse)

  • Is path and location free of obstructions, well lit, and identified with a highly visible sign?

  • Action Taken

  • Outlets are capped and protected from airborne contaminants?

  • Action Taken

  • Flow station for at least 30 sec, or longer for water to become clear - empty drain pail after testing

  • Action Taken

  • Flow to both eyes is equal, and at a velocity low enough to be non-injurious?

  • Action Taken

  • The shower handle is easy and accessible to operate, and easily activates without force, and flows water in one second or less upon activation?

  • Action Taken

Emergency Eyewash Station #2 (Tank Farm)

  • Is path and location free of obstructions, well lit, and identified with a highly visible sign?

  • Action Taken

  • Outlets are capped and protected from airborne contaminants?

  • Action Taken

  • Flow station for at least 30 sec, or longer for water to become clear - empty drain pail after testing

  • Action Taken

  • Flow to both eyes is equal, and at a velocity low enough to be non-injurious?

  • Action Taken

  • The shower handle is easy and accessible to operate, and easily activates without force, and flows water in one second or less upon activation?

  • Action Taken

Emergency Eyewash Station #3 (Rcvg Whse)

  • Is path and location free of obstructions, well lit, and identified with a highly visible sign?

  • Action Taken

  • Outlets are capped and protected from airborne contaminants?

  • Action Taken

  • Flow station for at least 30 sec, or longer for water to become clear - empty drain pail after testing

  • Action Taken

  • Flow to both eyes is equal, and at a velocity low enough to be non-injurious?

  • Action Taken

  • The shower handle is easy and accessible to operate, and easily activates without force, and flows water in one second or less upon activation?

  • Action Taken

Emergency Eyewash Station #4 (UV Filling)

  • Is path and location free of obstructions, well lit, and identified with a highly visible sign?

  • Action Taken

  • Outlets are capped and protected from airborne contaminants?

  • Action Taken

  • Flow station for at least 30 sec, or longer for water to become clear - empty drain pail after testing

  • Action Taken

  • Flow to both eyes is equal, and at a velocity low enough to be non-injurious?

  • Action Taken

  • The shower handle is easy and accessible to operate, and easily activates without force, and flows water in one second or less upon activation?

  • Action Taken

Emergency Eyewash Station #5 (Small Batch)

  • Is path and location free of obstructions, well lit, and identified with a highly visible sign?

  • Action Taken

  • Outlets are capped and protected from airborne contaminants?

  • Action Taken

  • Flow station for at least 30 sec, or longer for water to become clear - empty drain pail after testing

  • Action Taken

  • Flow to both eyes is equal, and at a velocity low enough to be non-injurious?

  • Action Taken

  • The shower handle is easy and accessible to operate, and easily activates without force, and flows water in one second or less upon activation?

  • Action Taken

Emergency Eyewash Station #6 (UV Lab)

  • Is path and location free of obstructions, well lit, and identified with a highly visible sign?

  • Action Taken

  • Outlets are capped and protected from airborne contaminants?

  • Action Taken

  • Flow station for at least 30 sec, or longer for water to become clear - empty drain pail after testing

  • Action Taken

  • Flow to both eyes is equal, and at a velocity low enough to be non-injurious?

  • Action Taken

  • The shower handle is easy and accessible to operate, and easily activates without force, and flows water in one second or less upon activation?

  • Action Taken

Emergency Eyewash Station #7 (UV Mezz)

  • Is path and location free of obstructions, well lit, and identified with a highly visible sign?

  • Action Taken

  • Outlets are capped and protected from airborne contaminants?

  • Action Taken

  • Flow station for at least 30 sec, or longer for water to become clear - empty drain pail after testing

  • Action Taken

  • Flow to both eyes is equal, and at a velocity low enough to be non-injurious?

  • Action Taken

  • The shower handle is easy and accessible to operate, and easily activates without force, and flows water in one second or less upon activation?

  • Action Taken

Emergency Eyewash Station #8 (Filling-New Side)

  • Is path and location free of obstructions, well lit, and identified with a highly visible sign?

  • Action Taken

  • Outlets are capped and protected from airborne contaminants?

  • Action Taken

  • Flow station for at least 30 sec, or longer for water to become clear - empty drain pail after testing

  • Flow to both eyes is equal, and at a velocity low enough to be non-injurious?

  • Action Taken

  • The shower handle is easy and accessible to operate, and easily activates without force, and flows water in one second or less upon activation?

  • Action Taken

Emergency Eyewash Station #9 (Shipping Dock #9)

  • Is path and location free of obstructions, well lit, and identified with a highly visible sign?

  • Action Taken

  • Outlets are capped and protected from airborne contaminants?

  • Action Taken

  • Flow station for at least 30 sec, or longer for water to become clear - empty drain pail after testing

  • Action Taken

  • Flow to both eyes is equal, and at a velocity low enough to be non-injurious?

  • Action Taken

  • The shower handle is easy and accessible to operate, and easily activates without force, and flows water in one second or less upon activation?

  • Action Taken

Emergency Eyewash Station #10 (Filling-Drum Line)

  • Is path and location free of obstructions, well lit, and identified with a highly visible sign?

  • Action Taken

  • Outlets are capped and protected from airborne contaminants?

  • Action Taken

  • Flow station for at least 30 sec, or longer for water to become clear - empty drain pail after testing

  • Action Taken

  • Flow to both eyes is equal, and at a velocity low enough to be non-injurious?

  • Action Taken

  • The shower handle is easy and accessible to operate, and easily activates without force, and flows water in one second or less upon activation?

  • Action Taken

Emergency Eyewash Station #11 (Filling Line #2)

  • Is path and location free of obstructions, well lit, and identified with a highly visible sign?

  • Action Taken

  • Outlets are capped and protected from airborne contaminants?

  • Action Taken

  • Flow station for at least 30 sec, or longer for water to become clear - empty drain pail after testing

  • Action Taken

  • Flow to both eyes is equal, and at a velocity low enough to be non-injurious?

  • Action Taken

  • The shower handle is easy and accessible to operate, and easily activates without force, and flows water in one second or less upon activation?

  • Action Taken

Emergency Eyewash Station #12 (Shipping Office)

  • Is path and location free of obstructions, well lit, and identified with a highly visible sign?

  • Action Taken

  • Outlets are capped and protected from airborne contaminants?

  • Action Taken

  • Flow station for at least 30 sec, or longer for water to become clear - empty drain pail after testing

  • Action Taken

  • Flow to both eyes is equal, and at a velocity low enough to be non-injurious?

  • Action Taken

  • The shower handle is easy and accessible to operate, and easily activates without force, and flows water in one second or less upon activation?

  • Action Taken

Emergency Eyewash Station #13 (Mixing Mezz)

  • Is path and location free of obstructions, well lit, and identified with a highly visible sign?

  • Action Taken

  • Outlets are capped and protected from airborne contaminants?

  • Action Taken

  • Flow station for at least 30 sec, or longer for water to become clear - empty drain pail after testing

  • Action Taken

  • Flow to both eyes is equal, and at a velocity low enough to be non-injurious?

  • Action Taken

  • The shower handle is easy and accessible to operate, and easily activates without force, and flows water in one second or less upon activation?

  • Action Taken

Emergency Eyewash Station #14 (Mixing Mezz)

  • Is path and location free of obstructions, well lit, and identified with a highly visible sign?

  • Action Taken

  • Outlets are capped and protected from airborne contaminants?

  • Action Taken

  • Flow station for at least 30 sec, or longer for water to become clear - empty drain pail after testing

  • Action Taken

  • Flow to both eyes is equal, and at a velocity low enough to be non-injurious?

  • Action Taken

  • The shower handle is easy and accessible to operate, and easily activates without force, and flows water in one second or less upon activation?

  • Action Taken

Emergency Eyewash Station #15 (QA Lab)

  • Is path and location free of obstructions, well lit, and identified with a highly visible sign?

  • Action Taken

  • Outlets are capped and protected from airborne contaminants?

  • Action Taken

  • Flow station for at least 30 sec, or longer for water to become clear - empty drain pail after testing

  • Action Taken

  • Flow to both eyes is equal, and at a velocity low enough to be non-injurious?

  • Action Taken

  • The shower handle is easy and accessible to operate, and easily activates without force, and flows water in one second or less upon activation?

  • Action Taken

Emergency Eyewash Station #16 (QA Back Room)

  • Is path and location free of obstructions, well lit, and identified with a highly visible sign?

  • Action Taken

  • Outlets are capped and protected from airborne contaminants?

  • Action Taken

  • Flow station for at least 30 sec, or longer for water to become clear - empty drain pail after testing

  • Action Taken

  • Flow to both eyes is equal, and at a velocity low enough to be non-injurious?

  • Action Taken

  • The shower handle is easy and accessible to operate, and easily activates without force, and flows water in one second or less upon activation?

  • Action Taken

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.