Form Dhs 4653 - Eyewash Weekly "15 Minute" Flush Record / Instruction Record

Eyewash Weekly “15 Minute” Flush Record / Instruction Record

1. The eyewash station MUST have an unobstructed path, accessible within 10 seconds.

2. Water must flow for at least 15 minutes. Valves must remain open without the use of hands.

Office of Developmental Disabilities

Stabilization and Crisis Unit

3. Eyewash must be clean, sanitary, and operating correctly.

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December

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Location of eyewash

The distance from the worker’s location to the device should not exceed 10 seconds walking distance. The determinant factor is immediate eye irrigation within 10 seconds. The

path must be unobstructed and cannot require opening doors or passing through obstacles unless other employees are always present to help the exposed employee.

Valve operation: Stay-open valves must be in place and be operable to allow an individual to use both hands to hold eyes open or remove clothing. Eye wash stations are to be

readily available. Caps for stations must be used.

Temperature: Elevated water temperatures may accelerate adverse chemical reactions.

Eyewash Weekly “15 Minute” Flush Record

POST THIS ABOVE EYEWASH SINK for WEEKLY SIGN OFF

DHS 4653 (08/14)