Weekly Emergency Eyewash Inspection Form
Department of Safety and Environmental Management
Created: 2/1/18
Revision: 12/17/2019 1 | Page
Visually inspect and operate the eyewash each week. Flush the eyewash for approximately 30
seconds or until you have verified that the eyewash is properly operating. Review all items listed
below and sign your initials in the box for that week. If you find any problems, place the eyewash
out of service and have it repaired immediately. If you have any questions, please contact
Department of Safety and Environmental Management.
Eyewash and surrounding area
• The eyewash is free from obstructions.
• The location of the eyewash is within 10 seconds or 55 feet of unobstructed travel
• The location of the eyewash is readily identifiable with a highly visible sign.
• The nozzles are covered to protect from dust and other airborne contaminants.
• The basin is clean and free of debris.
• The nozzle height is between 33 inches and 45 inches from the floor.
• The nozzles must be a minimum of 6 inches from the adjacent wall.
• The eyewash does not have signs of leaks or excessive corrosion.
• The valve actuator (i.e. operation paddle) allows water to flow within one second or less
• The valve actuator stays open and water continues to flow upon release
• The water flow is adequate to flush both eyes simultaneously
• The water flow is sufficient enough to remove the nozzle covers
• The water temperature is tepid or lukewarm to the touch (60-100°F)
