Templates
Annual eyewash inspection checklist

Annual eyewash inspection checklist

Conduct thorough annual inspections of emergency eyewash stations to ensure ANSI Z358.1 compliance and worker safety.

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Annual eyewash inspection checklist

Conduct thorough annual inspections of emergency eyewash stations to ensure ANSI Z358.1 compliance and worker safety.

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

Ensure your emergency eyewash stations are fully functional and compliant with this annual eyewash inspection checklist. The template guides you through evaluating critical factors like accessibility, signage, fluid temperature, and flow duration. With emergency eyewash stations requiring annual inspection for ANSI Z358.1 compliance, this checklist provides the structured approach you need.

Imagine discovering a malfunctioning valve during your inspection that would have prevented proper operation in an emergency – this template helps identify such issues before they become dangerous failures, potentially preventing serious eye injuries.

Related categories

Preview of the template
General Information
Inspection Site
Combination unit number
Inspection conducted by
Date & Time
Unit Inspection
Accessibility, Location & Positioning
Is the eyewash station at least 15 cm away from the nearest obstruction?
Are protective covers installed on each nuzzle to prevent airborne contamination?
Can the unit be reached within 10 seconds or 15 meters?
Is the unit on the same level as the hazard?
Is the unit free from obstructions?
Is the unit well-lit?
Is the unit identified with signage?
Fluid Delivery, Capacity & Temperature
Is the water tepid (15-37°C) and protected from freezing or excess heat?
Is the unit free from leakage?
Can the water supply be turned from "off" to "on" in less than one second?
Does the water remain flowing without user's assistance?
Does the unit provide full flow for 15 minutes?
Sign Off
Additional comments or remarks
Photo proof if necessary
Recommendations
Signature
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Frequently asked questions

What documentation should I maintain with my completed annual eyewash inspection checklist?

Keep records of inspection dates, inspector names, specific findings, corrective actions taken, and photographic evidence of compliance or issues. These records should be maintained for at least three years and be readily accessible during regulatory inspections. Include any maintenance performed as a result of inspection findings.

How do I check if the eyewash nozzle covers function properly during inspection?

Test the nozzle covers by activating the eyewash and observing if they automatically remove themselves from the water flow path. The covers should move away instantly without manual intervention and without obstructing the water pattern. This ensures dust and contaminants don’t block the nozzles while still allowing immediate use during emergencies

What should I do if I find non-compliance issues during my annual eyewash inspection?

Document all non-compliance issues with photos and detailed notes, then implement corrective actions immediately. Serious issues like inadequate water flow or broken valves require taking the station out of service with clear signage directing to alternative stations. Follow up with maintenance personnel and schedule a re-inspection after repairs are completed.

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.