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Eyewash weekly inspection form

Eyewash weekly inspection form

This weekly inspection checklist is for verifying compliance with ANSI Z358.1 requirements for workplace safety and emergency preparedness.

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Eyewash weekly inspection form

This weekly inspection checklist is for verifying compliance with ANSI Z358.1 requirements for workplace safety and emergency preparedness.

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

The eyewash weekly inspection form helps you check if your emergency eyewash stations remain fully operational when workers need them most. You can record water temperature, nozzle condition, and activation ease—critical elements required by OSHA standards. When a chemical splash occurs, seconds matter, and a malfunctioning station can lead to permanent eye damage.

According to ANSI Z358.1-2014, weekly activation is essential to verify proper operation of eyewash stations, flushing stagnant water that may harbor harmful microorganisms. With consistent documentation using this form, you can better maintain compliance while providing reliable emergency response equipment for your team.

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Preview of the template
Eyewash Weekly Inspection
Water temperature
Nozzle condition
Activation ease

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Frequently asked questions

How do I properly check the nozzle condition for the inspection form?

Examine nozzles for dust caps that remove automatically when activated, debris buildup, corrosion, or damage. Water should flow evenly from both eyepieces with equal pressure. Note any irregularities on the form and clean nozzles if needed. Replace protective dust covers after inspection to prevent contamination.

What makes activation “easy” versus “difficult” on the inspection form?

Activation is “easy” when the valve operates with a single motion and stays open without requiring hands to hold it. Mark “difficult” if it requires excessive force, sticks, or doesn’t remain open hands-free. Ideally, activation should in one second or less—anything slower needs immediate attention.

What if I encounter an issue during inspection?

Immediately notify your safety manager and create a work order for repairs. Document the specific issue and corrective actions taken. If the station is unusable, place signage directing to the nearest alternative eyewash station and expedite repairs to maintain workplace safety compliance.

What if our eyewash station is rarely used—do I still need weekly inspections?

Yes, weekly inspections remain mandatory regardless of usage frequency. Infrequently used stations are actually more prone to issues like mineral buildup, stagnant water, and mechanical problems. Regular activation ensures the station will function properly during an emergency and prevents bacterial growth in standing water.


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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