Emergency eye wash and safety shower inspection form. To ensure that eyewash stations and showers are always ready when needed, it is important that the requirements for test procedures and maintenance set forth in z358. The covers are removed by eyewash activation the water is flowing from both eyepieces. Is the area around the station clear of obstructions. As such, they are a form of first aid equipment to be used in the event of an. Eyewash stations must be easily identifiable and unobstructed. They have a total of five eyewash stations and maintain a log of weekly inspections. Streams of water meet in the middlesufficiently can reach user eyes of the eyewash. Initial and date in the corresponding box verifying the eyewash station is checked weekly for the following. Sign, fax and printable from pc, ipad, tablet or mobile with pdffiller. These selfcontained eye wash units must be checked on a weekly. Eyewash inspection and monitoring record fill online, printable.
Always note any problems with the operation then initial and date the log e. Plumbed eyewash stations require weekly checks to be compliant with ansi z358. Uaf is an aaeo employer and educational institution and prohibits illegal discrimination against any individual. We have an eyewash inspection log available for download environmental health and safety will inspect all eyewashes and safety showers twice per year. The eyewash and shower station weekly inspection check list e. A fire extinguisher tag can be used for this or the checklist below can be used and placed in a.
Use this checklist to help you stay in compliance and identify problem areas that need to be addressed. Monitor that the provided emergency eyewash station weekly activation log is maintained by each laboratory. Inside of eyewash cap must be cleaned weekly with alcohol. Eyewash weekly checklist q eyewash is accessible within 10 seconds, or roughly 55 feet commonly referred to as the 10 second rule q no pallets, ladders, buckets, boxes, or other potential hazards are obstructing the path between the hazard and the eyewash station q eyewash is at the same level as the hazard q area is well lit q light bulbs and light ixtures are in working condition. Researchers in laboratories registered with the state of connecticut department of public. Check for leaks, damage, unsanitary conditions, or anything else that would prevent proper operation. Emergency eyewash and shower units are designed to deliver water to rinse contaminants from a users eyes, face or body.
Testing eyewashes and emergency safety showers flinn scientific. Guardian 250060r emergency equipment inspection log tags. Iupui weekly eyewash station maintenance log year location. The book provides a checklist to help identify some of the significant requirements included in ansi z358. Emergency eye wash and shower units in an ideal workplace, employers would. Laboratory weekly eyeface wash inspection log applicability.
Michigan state university environmental health and safety. Does the eyewash station show any physical signs of chemical contamination. Eyewash station maintenance log template excel templates by. Initial and date in the corresponding box verifying that the emergency eyewash. Record the activation flushings in your record book or posted on the wall near the eyewash. Evaluate adequate flow streams of water should cross. Eyewash station weekly checklist osha healthcare advisor. It includes a checklist and safety audit survey as well as providing details on the requirements for emergency shower and eye wash stations. Water must come on within one second of activation.
Regular inspection is required to ensure these safety devices are ready at all times. Eye wash station inspection form form resume examples by. Fire department truck checklist tsfiretraining com by. Activate eyewash station by pushing the handle assembly or stepping on the foot assembly to start the water flow. Activate plumbed drench hoses weekly to verify proper operation and visually check selfcontained drench hoses weekly to determine if flushing fluid needs to be. Will it be outdoors and exposed to freezing or extremely hot temperatures. The area should be kept neat and easily accessible with at least 32 inches of clear space around a safety shower and 6 inches clearance around an eyewash. If your eyewash station does not have a weekly log already attached. Emergency eyewash testing log all eyewashes both plumbed and selfcontained models must be inspected on a weekly basis.
Please print and use the attached checklist that includes the reminders below. Testing eyewashes and emergency safety showers scientific. Use this form or a similar one to document weekly testing by lab staff of eyeface wash units located next to sinks or attached to faucets where water can drain without causing a spill. The emergency eyewash and shower program at the university of massachusetts, amherst uma was developed to offer guidance on the proper installation, inspection and repair of eyewashes and drench showers. The front of this card reads emergency equipment inspection log as well as test all emergency equipment at least weekly in accordance with ansi z358. Check lists should be available in the lab for verification during routine safety compliance inspections. Keep weekly eyewash inspection log sheet for 3 years. Guardian g1814p wall mounted emergency eyewash station, plastic bowl product code. If there are any issues, tag unit out of service and call facilities at 2034326888 to request that the unit be repaired as soon as possible.
Emergency showers and eyewash stations safety program. Eyewash stations require weekly checks to be compliant with the american national standards institute which. Do not use for overhead showers or other equipment where water can not be easily directed to a drain. Units have been tested to and comply with ansi z358.
If your eyewash station does not have a weekly log already attached to the fixture, use this log to check the proper functioning of the station and to. Verify that flow is continuous from both eyepieces. A station where eyewash bottles andor a supplemental eyewash facility are located to enable initial andor supplemental flushing of the eyes and surrounding facial area. Guardian 250060r emergency equipment inspection log tags, 20pkg.
Eyewash station checklist eyewash log video dailymotion. Plumbed eye wash stations must be activated weekly to verify proper operation. Position product name price popularity what makes it green manufacturer set descending direction. Eyewashes need to be inspected once per week by laboratory personnel. Weekly inspection checklist for central accumulation areas if you generate dangerous waste and use a central accumulation area caa, you must selfinspect your caa once a week from sunday to the following saturday. Legislation requirements for providing access to emergency showers and emergency eyewash stations are stated in. Emergency eyewash station weekly inspection checklist. Eyewashsafety shower monthly inspection log office. Secure water flow by placing handle assembly in the off position. Keep emergency shower and eye wash station equipment unobstructed and in good working condition. Verify that nozzle caps are in place to prevent contamination and that the nozzles, nozzle caps, and bowlsink. Single and dual head eyewashes, showers, drench hoses, combination units equipment must be run weekly for 3 minutes and until water is sedimentfree. Eyewash and safety shower dos and donts do keep the pathway to the emergency shower and eyewash clear of obstructions. Eye wash stations provide safety measures for workplace hazards, walk in emergency units, hazardous waste handlers, and a variety of other environments.
Conduct hazard assessments to determine necessity of emergency eyewash or shower. Uline stocks a huge selection of eyewash inspection station tags. Annual flow tests will be conducted by facility or safety personnel depending on the department policy and requires specialized equipment to conduct the test. Eyewash stations require weekly checks to be compliant with the american national standards institute which osha may reference during an inspection.
Forms environmental health, safety, and risk management. Refer to eyewash and shower station weekly inspection check list appendix a. The lightweight 9gallon portable eye wash station meets osha emergency eye wash station requirements and provides effective and immediate first aid eye irrigation, which is critical to helping people with eye injuries. Keep an inspection log book or attach an inspection tag to the eyewash. Fill eyewash inspection and monitoring record, edit online. Do log books show test strip quality control recording.
Weekly inspection checklist for central accumulation areas. Verify that bowl and spouts are clean and free of trash. Weekly eyewash inspection log fill out and sign printable pdf. Ensure that the path to the eyewashdrench hose is not obstructed. Wallmount eyewash stations offer low profile installation and the reliability of a permanently plumbed unit. Will the eyewashshower station be exposed to heavy dust or debris. Is there a bucket located under the eyewash to collect runoff. Several pages of the log but you may make as many copies of the log as you need. The university of alaska fairbanks is accredited by the northwest commission on colleges and universities. Emergency safety shower emergency safety showers may include body showers, drench hoses, and combination eyewashsafety shower units. However, it is not intended to be an interpretation of the entire ansi 358. Keep an eye wash test record or log in your laboratory.
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