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Emergency eyewash station inspection checklist

Emergency eyewash station inspection checklist

Conduct regular inspections of emergency eyewash stations to ensure proper functionality and ANSI Z358.1 compliance.

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Emergency eyewash station inspection checklist

Conduct regular inspections of emergency eyewash stations to ensure proper functionality and ANSI Z358.1 compliance.

Use this template with Lumiform

The Lumiform application helps frontline teams uphold internal standards effortlessly.
  • Customize this template or build your own
  • Fill out templates via mobile app
  • Assign and track corrective actions
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

Keep your emergency eyewash stations ready for action with this inspection checklist. When chemical splashes occur, properly maintained stations can mean the difference between minor irritation and permanent eye damage.

This template helps you verify that water is clear, jets function correctly, access remains unobstructed, and signage is legible. These are critical requirements under ANSI Z358.1-2014, which mandates weekly activation and documentation of eyewash stations. By conducting and recording these regular inspections, you’ll ensure your facility maintains compliance and protects workers from chemical hazards.

Related categories

  • Health and safety management templates
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  • Maintenance templates
  • Safety templates
Preview of the template
General Information
Site
Inspection conducted by
Date & Time of Inspection
Eyewash Station Flushing
Please flush the emergency eyewash stations weekly and check for the following:
Is the water clear?
Are the jets working properly?
Is the area around the station clear of obstructions?
Is there a bucket under the eyewash to catch the runoff?
Is the instruction sign for the usage of the eyewash station clearly legible?
Is the emergency phone contact clearly legible?
Sign Off
Additional comments
Signature
This template was downloaded 60 times

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Access a complete set of resources aimed at maximizing safety, quality, and operational excellence, including detailed guides, related templates, and real-world use cases.

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Frequently asked questions

How can I use the “additional comments” section of this checklist effectively?

Use the additional comments section to document specific issues requiring maintenance, note water temperature observations, record parts that need replacement, or highlight accessibility concerns. This section provides valuable context for follow-up actions, creates a detailed maintenance history, and helps identify recurring problems. When completed thoroughly, it serves as crucial documentation for safety audits and regulatory compliance verification.

What should I do if I mark “No” for any items during my inspection?

If you mark “No” for any inspection item, immediately create an action plan to address the deficiency. Document the issue in the comments section, notify the appropriate maintenance personnel or safety officer, and establish a timeline for resolution. Follow up to ensure repairs are completed promptly, as non-compliant eyewash stations pose serious safety risks and potential regulatory violations. Always re-inspect after corrections are made.

Who needs to sign off on the completed eyewash station inspection checklist?

The inspection should be signed by the person who physically conducted the inspection, typically a safety officer, facility manager, or designated inspector with proper training. In some organizations, a supervisor or department head may also need to review and countersign the document. Establish clear accountability for inspection completion and follow-up actions through proper signature protocols based on your facility’s safety management system.


This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.
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