Emergency Exit Light Inspection Form
Inspector's Information
Inspected By
*
First Name
Last Name
Company Name
*
Emergency Exit Lights Condition
Please fill according to test results.
Rows
Location
Test Type
Test Date
Test Result
Repaired
Date Repaired
January
Monthly Test (30 Second Test)
Annual Test (90 Minute Test)
Successful
Failed
Yes
No
February
Monthly Test (30 Second Test)
Annual Test (90 Minute Test)
Successful
Failed
Yes
No
March
Monthly Test (30 Second Test)
Annual Test (90 Minute Test)
Successful
Failed
Yes
No
April
Monthly Test (30 Second Test)
Annual Test (90 Minute Test)
Successful
Failed
Yes
No
May
Monthly Test (30 Second Test)
Annual Test (90 Minute Test)
Successful
Failed
Yes
No
June
Monthly Test (30 Second Test)
Annual Test (90 Minute Test)
Successful
Failed
Yes
No
July
Monthly Test (30 Second Test)
Annual Test (90 Minute Test)
Successful
Failed
Yes
No
August
Monthly Test (30 Second Test)
Annual Test (90 Minute Test)
Successful
Failed
Yes
No
September
Monthly Test (30 Second Test)
Annual Test (90 Minute Test)
Successful
Failed
Yes
No
October
Monthly Test (30 Second Test)
Annual Test (90 Minute Test)
Successful
Failed
Yes
No
November
Monthly Test (30 Second Test)
Annual Test (90 Minute Test)
Successful
Failed
Yes
No
December
Monthly Test (30 Second Test)
Annual Test (90 Minute Test)
Successful
Failed
Yes
No
Inspector's Signature
*
Submit
Should be Empty: