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Personal Eye Wash Inspection

 
The station is not damaged *
The station is not exposed to direct sunlight *
The bottle(s) are undamaged and leak free *
The tamper evident seal is unbroken *
The eye wash solution has not expired *
The eye wash solution will not expire within two (2) months of this inspection *
If you choose "No" at anytime make a note in this field.
Usually printed near the bottom of the bottle, next to the expiration date.
Usually printed near the bottom of the bottle, next to the batch number.
Usually printed near the bottom of the bottle, next to the expiration date.
Usually printed near the bottom of the bottle, next to the batch number.
Inspector's Name *
Inspector's Name
Date Inspected *
Date Inspected