Sapling Grove ASC Annual Emergency Light 90 Minute Test

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

#1 Main Hall

• Pass/Fail

  Pass

  Fail

  N/A

• What was done to make the emergency light compliant?

#2 Waiting Area

• Pass/Fail

  Pass

  Fail

  N/A

• What was done to make the emergency light compliant?

#3 Pre-Op

• Pass/Fail

  Pass

  Fail

  N/A

• What was done to make the emergency light complioant?

#4 Supply Hall

• Pass/Fail

  Pass

  Fail

  N/A

• What was done to make the emergency light compliant>

#5 Electrical Room

• Pass/Fail

  Pass

  Fail

  N/A

• What waas done to make the emergency light compliant?

Length Of Test

• Note the start and the completion time of the test

• This signature certifies that I have completed the required test in accordance with NFPA 101 Section 7.9.3.1.1(3).

  Sign