Eyewash Station Inspection Form

An educational library of workplace documents — purpose, who completes them, when they are used, typical fields, common mistakes and how they connect. Linked to workplace safety, workplace training, occupations, industries and employment documents. Informational only — template examples, not legal advice or official documents; employers remain responsible and using a document does not guarantee compliance.

What an eyewash station inspection form is

An eyewash station inspection form is a checklist used to confirm that emergency eyewash units are accessible, clean and functioning, and that any solution is within its use-by date, so they are ready in an emergency.

This is an educational overview with a simplified example. It is not an official template; the eyewash provision a workplace needs follows from the risk assessment for the substances and processes in use.

Purpose

• Confirm the station is present, accessible and signed.
• Check that plumbed units flow and self-contained units are in date and sealed.
• Confirm cleanliness and that caps and covers are in place.
• Record the check and flag anything needing attention.

Who completes it

• A responsible person appointed by the employer.
• Findings are reported so units can be flushed, refilled or replaced.
• The employer decides who maintains the stations.
• The risk assessment determines what provision is needed.

When it is used

• On a regular cycle, including periodic flushing of plumbed units.
• After a unit has been used.
• When substances, processes or layout change.

Typical fields

• Station ID or location and date.
• Accessible, signed and unobstructed.
• Plumbed unit flushes and flows; self-contained unit in date and sealed.
• Clean, caps and covers in place.
• Action needed and checker sign-off.
• Example items only — adapt to the units installed.

Common mistakes

• Blocking access to the station with stock or equipment.
• Letting self-contained solution pass its use-by date.
• Not flushing plumbed units, so water sits stagnant.
• Missing or illegible signage.

Document workflow

Eyewash checks support the arrangements that flow from the risk assessment and any chemical safety information, and they sit alongside first aid and safety shower checks. A failed check triggers flushing, refilling or replacement; an eye injury triggers an accident report.

See the related documents below for what is commonly used with and completed after an eyewash station check.

Retention (high level)

Check records are typically retained for a period defined by the employer and any applicable rules. This page does not state a required period — confirm with the applicable law and the official authority.

Completing and sharing as a PDF

Checks are commonly recorded and stored as PDFs. Exporting to PDF supports the record; it does not make the check official or guarantee compliance.

Employer checklist

• Base eyewash provision on the risk assessment.
• Keep stations accessible, signed and unobstructed.
• Flush plumbed units and keep self-contained units in date.
• Act on findings and keep the records.

Worker notes

• Know where the nearest eyewash station is.
• Do not block access to it.
• Report a used, contaminated or out-of-date unit.

Country considerations

Requirements for emergency eyewash provision and maintenance vary by country, and the official authority differs. This page is general and high-level — not a statement of any country’s law and not a guarantee of validity.

Confirm current requirements with the official authority for your country and a qualified professional.

Who is responsible

The employer is responsible for suitable emergency provision, its maintenance and compliance. This page is an educational overview with a template example; it does not set your provision and does not transfer responsibility.