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Cook Inlet Offshore
Nikiski Onshore
Anchorage
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Eyewash/Safety Shower Inspection
Monthly Inspection per ANSI Z358.1
30-DAY INSPECTION TRACKING
💧
ANSI Z358.1 requires weekly activation tests and annual comprehensive inspections. This monthly inspection supplements those requirements.
📋
Inspection Information
Inspector Name
*
Date
*
District / Base
*
Select District / Base...
Allegra Leigh (formerly Julius R)
Spartan 151 jack-up
Other
🚿
Station Information
Equipment Type
*
Select Type...
Combination Eyewash/Shower
Eyewash Station Only
Safety Shower Only
Portable Eyewash
Drench Hose
Eye/Face Wash
Station Number / ID
*
Check History
Specific Location
Manufacturer
Model
Water Temp (°F)
✓
Inspection Checklist
Accessibility & Signage
Section N/A
Location clearly identified with signage
Pass
Fail
N/A
Path to unit is unobstructed
Pass
Fail
N/A
Unit accessible within 10 seconds
Pass
Fail
N/A
Area well-lit
Pass
Fail
N/A
Floor area around unit is clear
Pass
Fail
N/A
Eyewash Components
Section N/A
Dust covers in place (if equipped)
Pass
Fail
N/A
Nozzles clean and free of debris
Pass
Fail
N/A
Heads align properly for eye flushing
Pass
Fail
N/A
Activation mechanism works smoothly
Pass
Fail
N/A
Stays-open valve functions properly
Pass
Fail
N/A
Flow pattern adequate for flushing
Pass
Fail
N/A
Shower Components (if equipped)
Section N/A
Shower head clean and unobstructed
Pass
Fail
N/A
Pull rod/handle operates freely
Pass
Fail
N/A
Stays-open valve functions
Pass
Fail
N/A
Adequate water coverage pattern
Pass
Fail
N/A
Drain functioning properly
Pass
Fail
N/A
Water Quality & Flow
Section N/A
Water flows immediately on activation
Pass
Fail
N/A
Water is clear (no discoloration)
Pass
Fail
N/A
No unusual odor in water
Pass
Fail
N/A
Water temperature tepid (60-100°F)
Pass
Fail
N/A
Adequate flow rate maintained
Pass
Fail
N/A
Portable Units Only
Section N/A
Solution level adequate
Pass
Fail
N/A
Solution not expired
Pass
Fail
N/A
Unit sealed/tamper indicator intact
Pass
Fail
N/A
General Condition
Section N/A
No visible corrosion or damage
Pass
Fail
N/A
Piping connections secure
Pass
Fail
N/A
Unit stable and properly mounted
Pass
Fail
N/A
Inspection tag current
Pass
Fail
N/A
📊
Overall Result
Inspection Result
*
Pass - Operational
Fail - Needs Repair
Out of Service
📝
Findings & Actions
Deficiencies Found
Corrective Actions
✅ Submit Eyewash/Shower Inspection
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