Emergency Shower Inspection Form
Document your routine emergency shower inspections to ensure safety and compliance.
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Time
*
Hour Minutes
AM
PM
AM/PM Option
Inspector Name
*
First Name
Last Name
Facility/Location
*
Shower Station ID
*
Shower Accessibility & Clearance
*
Clear and unobstructed
Partially obstructed
Blocked
Activation/Test Performed
*
Yes
No
Unable to test
Water Flow Adequacy
*
Adequate flow
Insufficient flow
No flow
Water Temperature
*
Within safe range (60-100°F / 16-38°C)
Too cold
Too hot
Not tested
Spray Pattern & Coverage
*
Full and even coverage
Partial or uneven
No spray
Equipment Condition
*
Good (no visible issues)
Minor wear (cosmetic only)
Damaged (affects function)
Obstructions or Damage Notes
Corrective Actions Required
Overall Inspection Status
*
Pass
Fail
Needs follow-up
Submit Inspection
Should be Empty: