Safety Shower and Eyewash Audit

• Document No.

• Institute Safety Shower and Eyewash Audit

• Conducted on

  Date

• Prepared by

• Personnel

Basement

• B.16 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• B.24 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• B.28 Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• B.33 Eyewash. Checked and in good condition?

  Yes

  No

  N/A

Level 1

• 1.04 Shower. Checked and in good condition?

  Yes

  No

  N/A

• 1.06 Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 1.36 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 1.41 Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 1.47 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

Level 2

• 2.02 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 2.06 Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 2.13 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 2.15 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 2.20 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 2.24 Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 2.30 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 2.31 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 2.32 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

Level 3

• 3.03 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 3.08 Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 3.11 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 3.33 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 3.34 Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 3.41 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

Level 4

• 4.11 Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 4.13 Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 4.19 Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 4.22 Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 4.25 Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 4.49 Eyewash x2. Both checked and in good condition?

  Yes

  No

  N/A

• 4.54 Eyewash. Checked and in good condition?

  Yes

  No

  N/A

Level 5

• 5.38 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 5.41 Eyewash. Checked and in good condition?

  Yes

  No

  N/A

• 5.48 Shower & Eyewash. Checked and in good condition?

  Yes

  No

  N/A

Sign off

• Inspectors signature

  Sign

Rectification

• All faulty equipment has been repaired or replaced?

  Yes

  No

  N/A

• Name and signature of person responsible for rectification.

  Sign