Emergency Lighting and Exit Sign Monthly Inspection

• Conducted on (Date and Time)

  Date

• Inspected by

• Address
  Address

Emergency Light Checks

• Visual Inspect Emergency Lights & Signage in general

Emergency Lights and Exit Signs

• Emergency light/signs location

• Are all the green LED ON

  Pass

  Fail

  Not all passed

  N/A

• Are the lights/signs secure and in good working order?

  Pass

  Fail

  Not all passed

  N/A
Faults Found

• Luminaire

  Pass

  Fail

• Exit Sign

  Pass

  Fail

• Running Man

  Pass

  Fail

Completion

• Observations

• Maintenance Inspector (Full Name and Signature)

  Sign