Renaissance Surgery Center Exit lights (Common Areas)

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

#1 Front Door

• Pass / Fail

  Pass

  Fail

  N/A

• Time (in seconds)

• Corrective Action

#2 Left Hall Near Surgery Entrance

• Pass / Fail

  Pass

  Fail

  N/A

• Time (in seconds)

• Corrective Action

#3 Right Hall Near Mens Restroom

• Pass / Fail

  Pass

  Fail

  N/A

• Time (in seconds)

• Corrective Action

• This signature certifies that I have reviewed and completed the inspection

  Sign