Title Page
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Site conducted
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Conducted on
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Prepared by
Untitled Page
#1 Waiting Area
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Pass/Fail
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What was done to make the exit sign compliant?
#2 Waiting Area
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Pass/Fail
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What was done to make the exit sign compliant?
#3 Waiting Area
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Pass/Fail
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What was done to make the exit sign compliant?
#4 Door To Waiting Area
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Pass/Fail
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What was done to make the exit sign compliant?
#5 Pre-Op
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Pass/Fail
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What was done to make the exit sign compliant?
#6 Pre-Op
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Pass/Fail
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What was done to make the exit sign compliant?
#7 Main Hall
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Pass/Fail
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What was done to make the exit sign compliant?
#8 Main Hall
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Pass/Fail
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What was done to make the exit sign compliant?
#9 Main Hall
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Pass/Fail
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What was done to make the exit sign compliant?
#10 Stairs Door Main Hall
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Pass/Fail
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What was done to make the exit sign compliant?
#11 Suit Front Door
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Pass/Fail
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What was done to make the exit sign compliant?
#12 Supply Hall
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Pass/Fail
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What was done to make the exit sign compliant?
#13 O.R. Hall
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Pass/Fail
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What was done to make the exit sign compliant?
#14 O.R. Hall
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Pass/Fail
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What was done to make the exit sign compliant?
#15 O.R. Hall
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Pass/Fail
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What was done to make the exit sign compliant?
#16 Back Door O.R.
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Pass/Fail
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What was done to make exit sign compliant?
Length Of Test
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Note the start and completion time of the test
Signature Page
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This signature certifies that I have completed the required test in accordance with NFPA 101 Section 7.9.3.1.1(3).
