Wilkie Emergency Eyewash Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Raw materials (wall)

• Are bottles unopened/missing?

  Yes

  No

  N/A

Water Jet (East Wall)

• Activated in 1 second or less?

  Yes

  No

  N/A

• Is area free of obstructions?

  Yes

  No

  N/A

• Is the flow of water clear?

  Yes

  No

  N/A

Sheet Metal (cabinet)

• Are bottles unopened/missing?

  Yes

  No

  N/A

Sheet Metal West

• Are bottles unopened/missing?

  Yes

  No

  N/A

Sheet Metal South

• Are bottles unopened/missing?

  Yes

  No

  N/A

Prop Clean Line

• Are bottles unopened/missing?

  Yes

  No

  N/A

Dye Pen

• Are bottles unopened/missing?

  Yes

  No

  N/A

Router Shop (wall)

• Are bottles unopened/missing?

  Yes

  No

  N/A

Router Shop (west wall)

• Is area free of obstructions?

  Yes

  No

  N/A

• Is the solution within 6 months of mixing date?

  Yes

  No

  N/A

• Are the pull straps tightly secured?

  Yes

  No

  N/A

Machine Shop (aisle)

• Are bottles unopened/missing?

  Yes

  No

  N/A

Debur Shop

• Activated in 1 second or less?

  Yes

  No

  N/A

• Is area free of obstructions?

  Yes

  No

  N/A

• Is the flow of water clear?

  Yes

  No

  N/A

C-103 Nozzle Pit

• Are bottles unopened/missing?

  Yes

  No

  N/A

Landing leg Area

• Are bottles unopened/missing?

  Yes

  No

  N/A

COPV Winding Tent

• Are bottles unopened/missing?

  Yes

  No

  N/A

Turbo Pump Assy

• Are bottles unopened/missing?

  Yes

  No

  N/A

Turbo Pump Assy (Acid etching)

• Are bottles unopened/missing?

  Yes

  No

  N/A

TPA G&B Room

• Are bottles unopened/missing?

  Yes

  No

  N/A

TPA Proof

• Are bottles unopened/missing?

  Yes

  No

  N/A

Machine Shop (Break Room)

• Activated in 1 second or less?

  Yes

  No

  N/A

• Is area free of obstructions?

  Yes

  No

  N/A

• Is the flow of water clear?

  Yes

  No

  N/A

Router Shop

• Is area free of obstructions?

  Yes

  No

  N/A

• Is the solution within 6 months of mixing date?

  Yes

  No

  N/A

• Are the pull straps tightly secured?

  Yes

  No

  N/A

Hazardous Waste Storage Area

• Activated in 1 second or less?

  Yes

  No

  N/A

• Is area free of obstructions?

  Yes

  No

  N/A

• Is the flow of water clear?

  Yes

  No

  N/A

Hazardous Material Storage

• Activated in 1 second or less?

  Yes

  No

  N/A

• Is area free of obstructions?

  Yes

  No

  N/A

• Is the flow of water clear?

  Yes

  No

  N/A