Renaissance Surgery Center Emergency Lights Inspection (Common Area)

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

#1 Front Door

• Pass / Fail

  Pass

  Fail

  N/A

• Time (in seconds)

• Corrective Acrtion

#2 Left Hall Before Surgery Entrance

• Pass / Fail

  Pass

  Fail

  N/A

• Time (in seconds)

• Corrective Action

#3 Right Hall Past Stairs

• Pass / Fail

  Pass

  Fail

  N/A

• Time (in sweconds)

• Corrective Action

#4 Back Hall

• Pass / Fail

  Pass

  Fail

  N/A

• Time (in seconds)

• Corrective Action

• Sign