Printable Eyewash Station Inspection Forms Details

When you work in a laboratory, it is important to follow the safety procedures established by your institution. One of the most important safety procedures is using an eyewash station when you get chemical in your eyes. The Eyewash Station Log Sheet can help you keep track of when you last used the eyewash station and whether or not it was effective. This sheet can also help you keep track of any other safety protocols that need to be followed.

If you want to learn a number of specific details pertaining to the PDF you will use, here is the information you might want to study prior to filling in the eyewash station log sheet.

Form NameEyewash Station Log Sheet
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other nameseyewash inspection and monitoring record, printable eyewash station checklist, eye wash weekly check sheet, safety affairs 448 6114

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




































































































































































Principal Investigator:



Room #: _________________________________

Version 2011.1

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