Chapter 53: Chemical Safety

Emergency Eyewash/Shower Activation Log

Form
ENVIRONMENT, SAFETY, HEALTH, AND Product ID: 229 | Revision ID: 1492 | Date Published: 20 May 2013 | Date Effective: 20 May 2013
QUALITY DIVISION URL: http://www-group.slac.stanford.edu/esh/eshmanual/references/chemsafetyFormShowerActivate.pdf

Emergency eyewash and shower stations are required in areas where workers can come into contact with injurious corrosive
chemicals. All eyewash and shower stations must be activated and the results logged on a tag attached to the station (see Chemical
Safety: Emergency Eyewash/Shower Requirements [SLAC-I-730-0A09S-043]). Print this form, cut out the tag, and attach it to the
station.

Emergency Eyewash/Shower
Activation Log
If this device passes, indicate the date and the initials of the inspector. If the
device fails, remove it from service/red tag it and notify ESH.
DATE BY DATE BY

DO NOT REMOVE THIS TAG

20 May 2013 SLAC-I-730-0A09J-003-R002 1 of 1