Title Page

  • Property Name

  • Location
  • Primary Site Contact Name and Title

  • Primary Site Contact Phone Number and Email

  • Secondary Site Contact Name, Title, Phone Number

  • Gate Code/Special Parking Instructions

  • Conducted on

  • Prepared by

1

  • Pictures ( At least 3)

  • Floor Number

  • Location

  • Existing Fixture

  • Existing Lamp Base

  • Existing Lamp Wattage

  • Lamps Per Fixture

  • Fixture Count

  • Hours of Operation

  • Emergency Ballasts?

  • Emergency Fixture Count

  • Mechanical Cooling-A/C?

  • Lift Required?

  • Notes

2

  • Pictures ( At least 3)

  • Floor Number

  • Location

  • Existing Fixture

  • Existing Lamp Base

  • Existing Lamp Wattage

  • Lamps Per Fixture

  • Fixture Count

  • Hours of Operation

  • Emergency Ballasts?

  • Emergency Fixture Count

  • Mechanical Cooling-A/C?

  • Lift Required?

  • Notes

3

  • Pictures ( At least 3)

  • Floor Number

  • Location

  • Existing Fixture

  • Existing Lamp Base

  • Existing Lamp Wattage

  • Lamps Per Fixture

  • Fixture Count

  • Hours of Operation

  • Emergency Ballasts?

  • Emergency Fixture Count

  • Mechanical Cooling-A/C?

  • Lift Required?

  • Notes

4

  • Pictures ( At least 3)

  • Floor Number

  • Location

  • Existing Fixture

  • Existing Lamp Base

  • Existing Lamp Wattage

  • Lamps Per Fixture

  • Fixture Count

  • Hours of Operation

  • Emergency Ballasts?

  • Emergency Fixture Count

  • Mechanical Cooling-A/C?

  • Lift Required?

  • Notes

5

  • Pictures ( At least 3)

  • Floor Number

  • Location

  • Existing Fixture

  • Existing Lamp Base

  • Existing Lamp Wattage

  • Lamps Per Fixture

  • Fixture Count

  • Hours of Operation

  • Emergency Ballasts?

  • Emergency Fixture Count

  • Mechanical Cooling-A/C?

  • Lift Required?

  • Notes

6

  • Pictures ( At least 3)

  • Floor Number

  • Location

  • Existing Fixture

  • Existing Lamp Base

  • Existing Lamp Wattage

  • Lamps Per Fixture

  • Fixture Count

  • Hours of Operation

  • Emergency Ballasts?

  • Emergency Fixture Count

  • Mechanical Cooling-A/C?

  • Lift Required?

  • Notes

7

  • Pictures ( At least 3)

  • Floor Number

  • Location

  • Existing Fixture

  • Existing Lamp Base

  • Existing Lamp Wattage

  • Lamps Per Fixture

  • Fixture Count

  • Hours of Operation

  • Emergency Ballasts?

  • Emergency Fixture Count

  • Mechanical Cooling-A/C?

  • Lift Required?

  • Notes

8

  • Pictures ( At least 3)

  • Floor Number

  • Location

  • Existing Fixture

  • Existing Lamp Base

  • Existing Lamp Wattage

  • Lamps Per Fixture

  • Fixture Count

  • Hours of Operation

  • Emergency Ballasts?

  • Emergency Fixture Count

  • Mechanical Cooling-A/C?

  • Lift Required?

  • Notes

9

  • Pictures ( At least 3)

  • Floor Number

  • Location

  • Existing Fixture

  • Existing Lamp Base

  • Existing Lamp Wattage

  • Lamps Per Fixture

  • Fixture Count

  • Hours of Operation

  • Emergency Ballasts?

  • Emergency Fixture Count

  • Mechanical Cooling-A/C?

  • Lift Required?

  • Notes

10

  • Pictures ( At least 3)

  • Floor Number

  • Location

  • Existing Fixture

  • Existing Lamp Base

  • Existing Lamp Wattage

  • Lamps Per Fixture

  • Fixture Count

  • Hours of Operation

  • Emergency Ballasts?

  • Emergency Fixture Count

  • Mechanical Cooling-A/C?

  • Lift Required?

  • Notes

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.