"Weekly Emergency Equipment Maintenance Log Template"

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LOCATION: _____________
MONTH: _____________ YEAR: _________ (Optional)
WEEKLY EMERGENCY EQUIPMENT MAINTENANCE LOG
Single and Dual Head Eyewashes, Showers, Drench Hoses, Combination Units
Equipment must be run WEEKLY for 3 minutes and until water is sediment-free.
Inside of eyewash cap must be cleaned WEEKLY with alcohol.
Water must come on within one second of activation.
Water must feel tepid (if so equipped).
Water must have adequate pressure (based on hand and visual inspection).
Eyewash caps must be present and in working condition.
Equipment In Good Working Condition?
Date Inspected
Inspected By
Corrective Actions Taken (if needed)
Y or N*
* IF EQUIPMENT IS NOT OPERATING PROPERLY, PROBLEM MUST BE REPORTED TO FACILITIES.
LOCATION: _____________
MONTH: _____________ YEAR: _________ (Optional)
WEEKLY EMERGENCY EQUIPMENT MAINTENANCE LOG
Single and Dual Head Eyewashes, Showers, Drench Hoses, Combination Units
Equipment must be run WEEKLY for 3 minutes and until water is sediment-free.
Inside of eyewash cap must be cleaned WEEKLY with alcohol.
Water must come on within one second of activation.
Water must feel tepid (if so equipped).
Water must have adequate pressure (based on hand and visual inspection).
Eyewash caps must be present and in working condition.
Equipment In Good Working Condition?
Date Inspected
Inspected By
Corrective Actions Taken (if needed)
Y or N*
* IF EQUIPMENT IS NOT OPERATING PROPERLY, PROBLEM MUST BE REPORTED TO FACILITIES.