Form library · Health and safety
Eyewash station checklist
For people checking eyewash readiness and replenishment. Record station and risk, readiness checks and checks and replenishment. Try the form below, see every question or download a blank PDF or Word copy.
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How should eyewash provision be selected?
HSE first-aid guidance requires provision to reflect assessed needs. COSHH assessment addresses hazardous-substance exposure. Select and maintain suitable eyewash equipment for the actual hazards and manufacturer instructions.
Last updated . Facts checked by the SiteSurvey team on 6 October 2026 against HSE first aid at work guidance and HSE COSHH assessment.
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Want to see one filled in? See a completed eyewash station check report (PDF), made by SiteSurvey from a fictional site visit.
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Your team completes the eyewash station check on site in the SiteSurvey app on iPhone, iPad and Android phones and tablets. The project name and address fill in for them, it works without signal, and it syncs when the device is back online with photos kept against the question they answer.
Customers and subcontractors do not need the app: send them a link and they can fill it in from any browser.
Every question in the eyewash station check template
An eyewash readiness record covering station identity, access, equipment condition, fluid dates, authorised checks and arrangements for defects. 6 sections and 36 questions. Follow-up questions and guidance appear only when an answer calls for them, so the person on site never sees the ones that do not apply.
Make it your own: every question is editable
This is a starting point, not a fixed form. Once it is in your SiteSurvey account you can reword any question, add or remove questions, sections and answer options, and add your own logo, so it fits the way your team works and the jobs you do.
Details you only enter once
Add this form to a project in SiteSurvey and it fills in what the project already knows, so nobody on site retypes it and every form on the job uses the same names. Anything filled in can still be changed.
- Project: the project name
- Site or premises address: the site address, from the space or the project
- Client or organisation: the project's customer
Record details and scope
- ProjectShort answer
Filled in from the project in SiteSurvey.
Fills in from the project name - Site or premises addressShort answerFills in from the site address, from the space or the project
- Client or organisationShort answerFills in from the project's customer
- Record date*Date
- Person completing the record*Short answer
- CheckThis records equipment readiness. It is not medical treatment advice, an ANSI or EN conformity certificate, or a universal flushing and testing procedure.
- CheckHSE first-aid guidance requires provision to reflect assessed needs. COSHH assessment addresses hazardous-substance exposure. Select and maintain suitable eyewash equipment for the actual hazards and manufacturer instructions.
Station and risk
- Station ID and location*Short answer
- Station type*Choose one
- Sealed bottles
- Plumbed eyewash
- Other approved unit
- Hazard assessment and first-aid needs reference*Short answer
- Manufacturer checking procedure and frequency*Short answer
Readiness checks
- Station is identifiable and accessible*Choose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- Action, limitation or reason not applicable*NotesShown only when the answers above make it relevant
- Unit, covers and nozzles visibly clean and intact*Choose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- Action, limitation or reason not applicable*NotesShown only when the answers above make it relevant
- Sealed fluid labels and expiry dates checked where applicable*Choose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- Action, limitation or reason not applicable*NotesShown only when the answers above make it relevant
- Operating instructions and reporting route available*Choose one
- Acceptable
- Action needed
- Not checked
- Not applicable
- Action, limitation or reason not applicable*NotesShown only when the answers above make it relevant
Checks and replenishment
- Fluid batch and expiry record where applicableShort answer
- Authorised operational check, actual result and procedure referenceNotes
- Items replaced and disposal referenceNotes
Record the affected item, expiry or defect and the replacement evidence. Use the installed equipment instructions to define the check.
- Next check under local scheduleDate
Handover
- Use decision*Choose one
- Available within recorded limits
- Restricted use
- Out of service
- Restrictions, isolation and person informed*NotesShown only when the answers above make it relevant
- Repair or follow-up job referenceShort answer
- Condition and defect evidencePhotos
Actions and review
- Are further actions required?*Choose one
- Yes
- No
- Further actionRepeat for each further action. Each one asks:Shown when “Are further actions required?” is “Yes”
- Action and evidence reference*Notes
- Person responsible*Short answer
- Target dateDate
- Action status*Choose one
- Open
- In progress
- Completed
- Completion evidence*NotesShown when “Action status” is “Completed”
- Outstanding limitations and information to pass onNotes
- Record status*Choose one
- Ready for review
- Further work needed
- Work or use stopped
- Reviewed byShort answer
- Review dateDate
- Author signature*Signature
- CheckSigning records the information entered. It does not itself certify legal compliance, remove a limitation or authorise unsafe work.
Scope and responsibility
This records equipment readiness. It is not medical treatment advice, an ANSI or EN conformity certificate, or a universal flushing and testing procedure.
What a useful entry looks like
Items replaced and disposal reference
Record the affected item, expiry or defect and the replacement evidence. Use the installed equipment instructions to define the check.
Expired container identified at station EW-02. Replacement item and its expiry are recorded before the station's readiness is reviewed.
Fictional example of record wording. Use the actual evidence and approved arrangements for your job; this is not a completed report or an instruction to carry out the work.
See it filled in
A completed eyewash station check report, made by SiteSurvey from a fictional site visit: every answer, the photos, the guidance that applied and the sign-off, ready to send as a PDF.
Eyewash Station Check FAQs
How should I record “Items replaced and disposal reference”?
Record the affected item, expiry or defect and the replacement evidence. Use the installed equipment instructions to define the check.
Should I open a sealed bottle for every check?
Follow the manufacturer instructions. Opening a sealed unit may affect its suitability; record any replacement required.
Does the form specify a flushing duration?
No. Equipment tests follow the approved procedure, while treatment instructions come from the relevant first-aid and exposure guidance.
What if the only station is unavailable?
Record the defect, notify the responsible person and document the temporary controls or work restrictions.
What are the limits of this template?
This records equipment readiness. It is not medical treatment advice, an ANSI or EN conformity certificate, or a universal flushing and testing procedure.
Can I complete this form on site and share the record?
In the SiteSurvey app the form works offline, with photos and signatures recorded against the questions. Share the completed record as a PDF or a link. Dates and action owners are recorded fields; this form does not send reminders or update other systems.
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