Title Page

  • Conducted on

  • Prepared by

Cement House-Downstairs

  • Is the station well lit, easily accessible, and have a legible sign marking its location?

  • Are the caps present and secured properly to the eyewash nozzles?

  • Does the eyewash valve/handle open and remain open until shut?

  • Does the pressure from the eyewash station meet the 30psi requirement?

  • How long does the eyewash station take to fill .5 gallons?

  • Does the eyewash station meet the <76 second flow rate requirement to fill .5 gallons?

  • Does the shower valve/handle open and remain open until shut?

  • How long does the shower take to fill 2 gallons?

  • Does the shower meet the <7 second flow rate requirement to fill 2 gallons?

  • Is the water tepid and can provide a full 15-minute flush if needed?

Cement House-Upstairs

  • Is the station well lit, easily accessible, and have a legible sign marking its location?

  • Are the caps present and secured properly to the eyewash nozzles?

  • Does the eyewash valve/handle open and remain open until shut?

  • Does the pressure from the eyewash station meet the 30psi requirement?

  • How long does the eyewash station take to fill .5 gallons?

  • Does the eyewash station meet the <76 second flow rate requirement to fill .5 gallons?

  • Does the shower valve/handle open and remain open until shut?

  • How long does the shower take to fill 2 gallons?

  • Does the shower meet the <7 second flow rate requirement to fill 2 gallons?

  • Is the water tepid and can provide a full 15-minute flush if needed?

MRC Lab

  • Is the station well lit, easily accessible, and have a legible sign marking its location?

  • Are the caps present and secured properly to the eyewash nozzles?

  • Does the eyewash valve/handle open and remain open until shut?

  • Does the pressure from the eyewash station meet the 30psi requirement?

  • How long does the eyewash station take to fill .5 gallons?

  • Does the eyewash station meet the <76 second flow rate requirement to fill .5 gallons?

  • Does the shower valve/handle open and remain open until shut?

  • How long does the shower take to fill 2 gallons?

  • Does the shower meet the <7 second flow rate requirement to fill 2 gallons?

  • Is the water tepid and can provide a full 15-minute flush if needed?

10" Tuber

  • Is the station well lit, easily accessible, and have a legible sign marking its location?

  • Are the caps present and secured properly to the eyewash nozzles?

  • Does the eyewash valve/handle open and remain open until shut?

  • Does the pressure from the eyewash station meet the 30psi requirement?

  • How long does the eyewash station take to fill .5 gallons?

  • Does the eyewash station meet the <76 second flow rate requirement to fill .5 gallons?

  • Does the shower valve/handle open and remain open until shut?

  • How long does the shower take to fill 2 gallons?

  • Does the shower meet the <7 second flow rate requirement to fill 2 gallons?

  • Is the water tepid and can provide a full 15-minute flush if needed?

QCT-2 (Tuber #10)

  • Is the station well lit, easily accessible, and have a legible sign marking its location?

  • Are the caps present and secured properly to the eyewash nozzles?

  • Does the eyewash valve/handle open and remain open until shut?

  • Does the pressure from the eyewash station meet the 30psi requirement?

  • How long does the eyewash station take to fill .5 gallons?

  • Does the eyewash station meet the <76 second flow rate requirement to fill .5 gallons?

  • Does the shower valve/handle open and remain open until shut?

  • How long does the shower take to fill 2 gallons?

  • Does the shower meet the <7 second flow rate requirement to fill 2 gallons?

  • Is the water tepid and can provide a full 15-minute flush if needed?

QCT Tuber

  • Is the station well lit, easily accessible, and have a legible sign marking its location?

  • Are the caps present and secured properly to the eyewash nozzles?

  • Does the eyewash valve/handle open and remain open until shut?

  • Does the pressure from the eyewash station meet the 30psi requirement?

  • How long does the eyewash station take to fill .5 gallons?

  • Does the eyewash station meet the <76 second flow rate requirement to fill .5 gallons?

  • Does the shower valve/handle open and remain open until shut?

  • How long does the shower take to fill 2 gallons?

  • Does the shower meet the <7 second flow rate requirement to fill 2 gallons?

  • Is the water tepid and can provide a full 15-minute flush if needed?

Sidewall Triplex

  • Is the station well lit, easily accessible, and have a legible sign marking its location?

  • Are the caps present and secured properly to the eyewash nozzles?

  • Does the eyewash valve/handle open and remain open until shut?

  • Does the pressure from the eyewash station meet the 30psi requirement?

  • How long does the eyewash station take to fill .5 gallons?

  • Does the eyewash station meet the <76 second flow rate requirement to fill .5 gallons?

  • Does the shower valve/handle open and remain open until shut?

  • How long does the shower take to fill 2 gallons?

  • Does the shower meet the <7 second flow rate requirement to fill 2 gallons?

  • Is the water tepid and can provide a full 15-minute flush if needed?

TCT Tuber

  • Is the station well lit, easily accessible, and have a legible sign marking its location?

  • Are the caps present and secured properly to the eyewash nozzles?

  • Does the eyewash valve/handle open and remain open until shut?

  • Does the pressure from the eyewash station meet the 30psi requirement?

  • How long does the eyewash station take to fill .5 gallons?

  • Does the eyewash station meet the <76 second flow rate requirement to fill .5 gallons?

  • Does the shower valve/handle open and remain open until shut?

  • How long does the shower take to fill 2 gallons?

  • Does the shower meet the <7 second flow rate requirement to fill 2 gallons?

  • Is the water tepid and can provide a full 15-minute flush if needed?

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.