GEN-FORM-082- EMERGENCY SHOWER AND EYEWASH MAINTENANCE LOG

YEAR _________________ LOCATION _________________

CHECK THAT THE EMERGENCY SHOWER AND THE EYEWASH ARE FUNCTIONING PROPERLY.
CHECK THAT THE WATER TEMPERATURE IS AMBIENT AND COMFORTABLE ON THE SKIN.

MONTH JANUARY FEBRUARY MARCH APRIL MAY JUNE LAB DIRECTOR

REVIEW
WEEK 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

CHECK SHOWER

CHECK EYEWASH

TEMPERATURE

INITIALS
MONTH JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER LAB DIRECTOR
REVIEW
WEEK 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
CHECK SHOWER

CHECK EYEWASH

TEMPERATURE

INITIALS

Date Service Log and Corrective Actions

Safety Officer's Review

GEN-FORM-082- Emergency Shower and Eyewash Maintenance Log Version 1

Sharing folder\CAP\Lab Forms\General 01/11/2022