Meadowview Surgery Center 90 Minute Emergency Light Illumination Test

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

#1 Pre-Op Light #1

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#2 Pre-Op Light #2

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#3 Pre-Op Light #3

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#4 OR Hall Way Light #4

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute tes?

  Yes

  No

  N/A

#5 OR Hallway Light #5

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#6 OR Hallway Light #6

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#7 Women's Dressing Room #7

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#8 Women's Dressing Room #8

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#9 OR Room 1 Light #9

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#10 OR Room 1 Light #10

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#11 OR Room 1 Light #11

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#12 OR Room 1 Light #12

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#13 OR Room 1 Light #13

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#14 OR Room 1 Light #14

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#15 OR Room 1 Light #15

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#16 OR Room 1 Light #16

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#17 OR Room 1 Light #17

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minutes test?

  Yes

  No

  N/A

#18 OR Room 1 Light #18

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#19 OR Room 1 Light #19

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#20 OR Room 2 Light #20

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#21 OR Room 2 Light #21

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#22 OR Room 2 Light #22

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#23 OR Room 2 Light #23

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#24 OR Room 2 Light #24

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#25 OR Room 2 Light #25

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#26 OR Room 2 Light #26

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#27 OR Room Light #27

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#28 OR Room 2 Light #28

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#29 OR Room 2 Light #29

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#30 OR Room 2 Light #30

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#31 OR Room 3 Light #31

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#32 OR Room 3 Light #32

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#33 OR Room 3 Light #33

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute tets?

  Yes

  No

  N/A

#34 OR Room 3 Light #34

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#35 OR Room 3 Light #35

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#36 OR Room 3 Light #36

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#37 OR Room 3 Light #37

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#38 OR Room 3 Light #38

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#39 OR Room 3

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#40 OR Room 3 Light #40

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#41 OR Room 3 Light #41

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#42 Decon Hallway Light #42

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#43 Decon Hallway Light #43

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#44 Recovery Room Light #44

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pas the 90 minute test?

  Yes

  No

  N/A

#45 Recovery Room Light #45

• Is the room on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#46 Recovery Room Light #46

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#47 Recovery Room Light #47

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#48 Recovery Room Light #48

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#49 Front Office Light #49

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#50 Front Lobby Light #50

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#51 Front Lobby Light #51

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#52 Mechanical Room Light #144

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#53 Mechanical Room Light #155

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

Document The Time Below

• How long did the test last in minutes

• What time was the test completed?

• This signature certifies that I have completed the inspection in accordance with NFPA 101, Section 7.9.2.1.

  Sign