Safety Shower Inspection Checklist Form
Complete this checklist to document the inspection and condition of an emergency safety shower.
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
First Name
Last Name
Location or Equipment ID
*
Is the safety shower easily accessible?
*
Yes
No
Is the shower free from visible damage or obstructions?
*
Yes
No
Does the water flow activate properly?
*
Yes
No
Is the water clear and free of debris?
*
Yes
No
Are operating instructions and signage visible?
*
Yes
No
Observed Issues (if any)
Corrective Actions Taken
Submit Inspection
Should be Empty: