Eyewash Station Log Sheet PDF Details

In the realm of workplace safety, ensuring the operational integrity of emergency equipment is paramount, a principle that guides the meticulous use of the Eyewash Station Log Sheet form. Drafted by Safety Affairs, this document serves as a crucial tool designed to uphold the highest standards of safety within environments prone to hazardous exposures. By systematically checking the functionality of eyewash stations—devices critical for the immediate dilution of harmful substances in contact with the eyes—this weekly inspection form underscores the importance of readiness in preventing eye injuries. Each section of the form highlights specific checkpoints, such as the unobstructed access to the station, the operational status of nozzle dust caps, and the clarity and cleanliness of the water emitted. For any identified issues, the form directs the responsible parties towards immediate corrective action, thereby ensuring a prompt response to potential safety hazards. Alongside these procedural details, the log also facilitates a structured reporting mechanism, capturing the date and initial of the person conducting the inspection, while offering space for comments that might be critical for follow-up actions. In essence, this document not only represents a routine safety protocol but embodies the commitment to maintaining a secure workspace through meticulous oversight and proactive measures.

QuestionAnswer
Form NameEyewash Station Log Sheet
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameseyewash form, eyewash weekly form, printable eyewash station inspection forms, eyewash inspection sheet requirements osha

Form Preview Example

Safety Affairs 448-6114

Eyewash Weekly Inspection Form

An emergency eyewash fixture is provided to flush tepid water to the eye, diluting any hazardous materials that may have come into contact with the eyes.

General Requirements:

Initial and date in the corresponding box verifying the eyewash station is checked weekly for the following:

The pathway to the eyewash station is clear of obstructions

The eyewash fixture is free of obstructions in all directions

The nozzle dust caps/covers are in place and operating properly

To test the eyewash station, flush water until clear water flows continually through eyewash

head without any leaks, rust, dirt, etc. for approximately 5 seconds. ( If problems are evident, call Physical Plant at 85661)

 

 

 

Call Safety Affairs (at 86114) with any questions

 

Year ______

 

Week 1

Week 2

Week 3

Week 4

Week 5

Comments:

 

JANUARY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FEBRUARY

 

 

 

 

 

 

 

 

MARCH

 

 

 

 

 

 

 

 

APRIL

 

 

 

 

 

 

 

 

MAY

 

 

 

 

 

 

 

 

JUNE

 

 

 

 

 

 

 

 

JULY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AUGUST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SEPTEMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OCTOBER

 

 

 

 

 

 

 

 

NOVEMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DECEMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Principal Investigator:

____________________________________________

 

Room #: _________________________________

Version 2011.1

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