Renaissance Surgery Center 90 Minute Emergency Light Illumination Test

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

#1 OR 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 OR 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 Treatment Room

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#4 Mechanical Room

• Is the light on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute tes?

  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