Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 1

LOCATION LUNCH ROOM ID FOR THE MONTH OF

LEGEND OK – ACCEPTABLE, NOT - NOT ACCEPTABLE, ELM– EQUIPMENT LOST OF MISSING, REP – EQUIPMENT BEING REPAIRED, N/A – NOT APPLICABLE
RAISE THE ISSUES THROUGH CORRECTION REPORT (BEFORE & AFTER PHOTO) FOR ACTION TAKEN

01/08/2018
Date/
Time

Emergency Signs
Controls (Levers/
Chains/Floor step)
Water supply control
valve (open)
Water Temperature

Strength of water flow

Equipment clean

Floor Demarcation

Cleaning Supplies

Emergency Numbers
posted

Signature By Cleaner

Accepted By Site
Reviewed By Safety Officer Date Sign Date Sign
Manager

PROJECT / DEPARTMENT NAME : __________________________


ELEMENT 1.4d
EMERGENCY SHOWER EYE WASH INSPECTION CHECKLIST

Doc. no : El.1.4d Issue Date: 01.07.18 Rev. No . 01 Page 1 of 1

You might also like