Meadowview Surgery Center 90 Minute Exit Light Illumination Test

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

#1 Exit Sign #9 Lobby/Waiting Area

• Is the exit sign on a generator curcuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#2 Exit Sign #10 Front Office

• Is the exit sign on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#3 Exit Sign #11 Pre-Op Entrance

• Is the exit sign on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#4 Exit Sign #12 Entrance To The Sterile Hallway

• Is the exit sign on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#5 Exit Sign #13 Decon Hallway

• Is the exit sign on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#6 Exit Sign #14 Entrance To Sterile Hallway

• Is the exit sign on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#7 Exit Sign #15 G.S. Decon

• Is the exit sign on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#8 Exit Sign #16 Back Door PACU

• Is the exit sign 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