VP5 Weekly Safety Shower & Eye Wash Inspection

• Conducted on

  Date

• Completed by

Unit Number 1

• Unit Type?

  Select Eye Wash & Safety Shower Station Eye Wash Station (only) Safety Shower Station (only)

  • Eye Wash & Safety Shower Station
  • Eye Wash Station (only)
  • Safety Shower Station (only)

• Unit Station Photo

  Media

• Is the unit easily accessible and free from any obstacles?

  Yes

  No

  N/A

• Is the unit reasonably clean?

  Yes

  No

  N/A

• Pipework and unit free from any damange or leaks? (Visually inspect before testing)

  Yes

  No

  N/A

• Activate unit and flush pipes until water is clear. Is the unit operational?

  Yes

  No

  N/A

• Equipment signage highly visible and damage free?

  Yes

  No

  N/A

Unit Number 2

• Unit Type?

  Select Eye Wash & Safety Shower Station Eye Wash Station (only) Safety Shower Station (only)

  • Eye Wash & Safety Shower Station
  • Eye Wash Station (only)
  • Safety Shower Station (only)

• Unit Station Photo

  Media

• Is the unit easily accessible and free from any obstacles?

  Yes

  No

  N/A

• Is the unit reasonably clean?

  Yes

  No

  N/A

• Pipework and unit free from any damange or leaks? (Visually inspect before testing)

  Yes

  No

  N/A

• Activate unit and flush pipes until water is clear. Is the unit operational?

  Yes

  No

  N/A

• Equipment signage highly visible and damage free?

  Yes

  No

  N/A

Unit Number 3

• Unit Type?

  Select Eye Wash & Safety Shower Station Eye Wash Station (only) Safety Shower Station (only)

  • Eye Wash & Safety Shower Station
  • Eye Wash Station (only)
  • Safety Shower Station (only)

• Unit Station Photo

  Media

• Is the unit easily accessible and free from any obstacles?

  Yes

  No

  N/A

• Is the unit reasonably clean?

  Yes

  No

  N/A

• Pipework and unit free from any damange or leaks? (Visually inspect before testing)

  Yes

  No

  N/A

• Activate unit and flush pipes until water is clear. Is the unit operational?

  Yes

  No

  N/A

• Equipment signage highly visible and damage free?

  Yes

  No

  N/A

Unit Number 4

• Unit Type?

  Select Eye Wash & Safety Shower Station Eye Wash Station (only) Safety Shower Station (only)

  • Eye Wash & Safety Shower Station
  • Eye Wash Station (only)
  • Safety Shower Station (only)

• Unit Station Photo

  Media

• Is the unit easily accessible and free from any obstacles?

  Yes

  No

  N/A

• Is the unit reasonably clean?

  Yes

  No

  N/A

• Pipework and unit free from any damange or leaks? (Visually inspect before testing)

  Yes

  No

  N/A

• Activate unit and flush pipes until water is clear. Is the unit operational?

  Yes

  No

  N/A

• Equipment signage highly visible and damage free?

  Yes

  No

  N/A

Unit Number 5

• Unit Type?

  Select Eye Wash & Safety Shower Station Eye Wash Station (only) Safety Shower Station (only)

  • Eye Wash & Safety Shower Station
  • Eye Wash Station (only)
  • Safety Shower Station (only)

• Unit Station Photo

  Media

• Is the unit easily accessible and free from any obstacles?

  Yes

  No

  N/A

• Is the unit reasonably clean?

  Yes

  No

  N/A

• Pipework and unit free from any damange or leaks? (Visually inspect before testing)

  Yes

  No

  N/A

• Activate unit and flush pipes until water is clear. Is the unit operational?

  Yes

  No

  N/A

• Equipment signage highly visible and damage free?

  Yes

  No

  N/A

Unit Number 6

• Unit Type?

  Select Eye Wash & Safety Shower Station Eye Wash Station (only) Safety Shower Station (only)

  • Eye Wash & Safety Shower Station
  • Eye Wash Station (only)
  • Safety Shower Station (only)

• Unit Station Photo

  Media

• Is the unit easily accessible and free from any obstacles?

  Yes

  No

  N/A

• Is the unit reasonably clean?

  Yes

  No

  N/A

• Pipework and unit free from any damange or leaks? (Visually inspect before testing)

  Yes

  No

  N/A

• Activate unit and flush pipes until water is clear. Is the unit operational?

  Yes

  No

  N/A

• Equipment signage highly visible and damage free?

  Yes

  No

  N/A

Unit Number 7

• Unit Type?

  Select Eye Wash & Safety Shower Station Eye Wash Station (only) Safety Shower Station (only)

  • Eye Wash & Safety Shower Station
  • Eye Wash Station (only)
  • Safety Shower Station (only)

• Unit Station Photo

  Media

• Is the unit easily accessible and free from any obstacles?

  Yes

  No

  N/A

• Is the unit reasonably clean?

  Yes

  No

  N/A

• Pipework and unit free from any damange or leaks? (Visually inspect before testing)

  Yes

  No

  N/A

• Activate unit and flush pipes until water is clear. Is the unit operational?

  Yes

  No

  N/A

• Equipment signage highly visible and damage free?

  Yes

  No

  N/A

Unit Number 8

• Unit Type?

  Select Eye Wash & Safety Shower Station Eye Wash Station (only) Safety Shower Station (only)

  • Eye Wash & Safety Shower Station
  • Eye Wash Station (only)
  • Safety Shower Station (only)

• Unit Station Photo

  Media

• Is the unit easily accessible and free from any obstacles?

  Yes

  No

  N/A

• Is the unit reasonably clean?

  Yes

  No

  N/A

• Pipework and unit free from any damange or leaks? (Visually inspect before testing)

  Yes

  No

  N/A

• Activate unit and flush pipes until water is clear. Is the unit operational?

  Yes

  No

  N/A

• Equipment signage highly visible and damage free?

  Yes

  No

  N/A

Unit Number 9

• Unit Type?

  Select Eye Wash & Safety Shower Station Eye Wash Station (only) Safety Shower Station (only)

  • Eye Wash & Safety Shower Station
  • Eye Wash Station (only)
  • Safety Shower Station (only)

• Unit Station Photo

  Media

• Is the unit easily accessible and free from any obstacles?

  Yes

  No

  N/A

• Is the unit reasonably clean?

  Yes

  No

  N/A

• Pipework and unit free from any damange or leaks? (Visually inspect before testing)

  Yes

  No

  N/A

• Activate unit and flush pipes until water is clear. Is the unit operational?

  Yes

  No

  N/A

• Equipment signage highly visible and damage free?

  Yes

  No

  N/A

Unit Number 10

• Unit Type?

  Select Eye Wash & Safety Shower Station Eye Wash Station (only) Safety Shower Station (only)

  • Eye Wash & Safety Shower Station
  • Eye Wash Station (only)
  • Safety Shower Station (only)

• Unit Station Photo

  Media

• Is the unit easily accessible and free from any obstacles?

  Yes

  No

  N/A

• Is the unit reasonably clean?

  Yes

  No

  N/A

• Pipework and unit free from any damange or leaks? (Visually inspect before testing)

  Yes

  No

  N/A

• Activate unit and flush pipes until water is clear. Is the unit operational?

  Yes

  No

  N/A

• Equipment signage highly visible and damage free?

  Yes

  No

  N/A

Unit Number 11

• Unit Type?

  Select Eye Wash & Safety Shower Station Eye Wash Station (only) Safety Shower Station (only)

  • Eye Wash & Safety Shower Station
  • Eye Wash Station (only)
  • Safety Shower Station (only)

• Unit Station Photo

  Media

• Is the unit easily accessible and free from any obstacles?

  Yes

  No

  N/A

• Is the unit reasonably clean?

  Yes

  No

  N/A

• Pipework and unit free from any damange or leaks? (Visually inspect before testing)

  Yes

  No

  N/A

• Activate unit and flush pipes until water is clear. Is the unit operational?

  Yes

  No

  N/A

• Equipment signage highly visible and damage free?

  Yes

  No

  N/A

Unit Number 12

• Unit Type?

  Select Eye Wash & Safety Shower Station Eye Wash Station (only) Safety Shower Station (only)

  • Eye Wash & Safety Shower Station
  • Eye Wash Station (only)
  • Safety Shower Station (only)

• Unit Station Photo

  Media

• Is the unit easily accessible and free from any obstacles?

  Yes

  No

  N/A

• Is the unit reasonably clean?

  Yes

  No

  N/A

• Pipework and unit free from any damange or leaks? (Visually inspect before testing)

  Yes

  No

  N/A

• Activate unit and flush pipes until water is clear. Is the unit operational?

  Yes

  No

  N/A

• Equipment signage highly visible and damage free?

  Yes

  No

  N/A

Unit Number 13

• Unit Type?

  Select Eye Wash & Safety Shower Station Eye Wash Station (only) Safety Shower Station (only)

  • Eye Wash & Safety Shower Station
  • Eye Wash Station (only)
  • Safety Shower Station (only)

• Unit Station Photo

  Media

• Is the unit easily accessible and free from any obstacles?

  Yes

  No

  N/A

• Is the unit reasonably clean?

  Yes

  No

  N/A

• Pipework and unit free from any damange or leaks? (Visually inspect before testing)

  Yes

  No

  N/A

• Activate unit and flush pipes until water is clear. Is the unit operational?

  Yes

  No

  N/A

• Equipment signage highly visible and damage free?

  Yes

  No

  N/A

Unit Number 14

• Unit Type?

  Select Eye Wash & Safety Shower Station Eye Wash Station (only) Safety Shower Station (only)

  • Eye Wash & Safety Shower Station
  • Eye Wash Station (only)
  • Safety Shower Station (only)

• Unit Station Photo

  Media

• Is the unit easily accessible and free from any obstacles?

  Yes

  No

  N/A

• Is the unit reasonably clean?

  Yes

  No

  N/A

• Pipework and unit free from any damange or leaks? (Visually inspect before testing)

  Yes

  No

  N/A

• Activate unit and flush pipes until water is clear. Is the unit operational?

  Yes

  No

  N/A

• Equipment signage highly visible and damage free?

  Yes

  No

  N/A