Site Evaluation

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Threshold

• Filters

  Yes

  No

  N/A

• Lamps out

  Yes

  No

  N/A

200 ft bar

• Lamps out

  Yes

  No

  N/A

400 ft bar

• Lamps out

  Yes

  No

  N/A

600 ft bar

• Yes

  No

  N/A

800 ft bar

• Lamps out

  Yes

  No

  N/A

1000 ft bar

• Yes

  No

  N/A

1200 ft bar

• Lamps out

  Yes

  No

  N/A

1400 ft bar

• Lamps out

  Yes

  No

  N/A

Flashers

• Flasher 1

  Yes

  No

  N/A

• Flasher 2

  Yes

  No

  N/A

• Flasher 3

  Yes

  No

  N/A

• Flasher 4

  Yes

  No

  N/A

• Flasher 5

  Yes

  No

  N/A

Lamp voltage

• Low (100v 5%) (50v 5%)

  Yes

  No

  N/A

• Med (75v 5%)(150v 5%)

  Yes

  No

  N/A

• High (120v 5%)(240v 5%)

  Yes

  No

  N/A

Input voltage

• (L-1 to N) 120v 5%<br>(L-2 to N) 120v 5%<br>(L-2 to L1) 240v 5%

  Yes

  No

  N/A

Remote control

• Operational

  Yes

  No

  N/A

Obstructions

• None

  Yes

  No

  N/A

TRDR

• Yes

  No

  N/A

Mods

• List mods.

  Yes

  No

  N/A

TPRs

• List discrepancy

  Yes

  No

  N/A

Paint, Stencil, Grounding

• List discrepancies

  Yes

  No

  N/A