Renaissance Surgery Center 90 Minute Exit Light Illumination Test

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

#1 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 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 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

#4 Recovery

• 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 Door at Supply Hall

• 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 Door In Back Hall

• 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 O.R. Hall Double Door

• 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 In Hall Outside O.R. #1

• Is the exit sign on a generator circuit?

  Yes

  No

  N/A

• Did the battery pass the 90 minute test?

  Yes

  No

  N/A

#9 O.R. Hall

• Is the exit sign on a generator circuit

  Yes

  No

  N/A

• Did the battery pass the 90 minute test

  Yes

  No

  N/A

#10 Back Door O.R. Hall

• 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