Lighting Shutdown Checklist
Complete this checklist to ensure all lighting systems are properly shut down at the end of operation.
Full Name of Person Completing Checklist
*
First Name
Last Name
Date of Shutdown
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Facility/Building Name
*
Area or Floor(s) Covered
*
Start Time of Shutdown Procedure
*
Hour Minutes
AM
PM
AM/PM Option
End Time of Shutdown Procedure
*
Hour Minutes
AM
PM
AM/PM Option
Which areas have been checked and lights turned off?
*
Offices
Conference Rooms
Restrooms
Hallways
Storage Rooms
Parking Areas
Other (please specify)
Were any lights found malfunctioning or unable to be turned off?
*
Yes
No
If yes, please specify the location(s) and issue(s) found
Additional Comments or Observations
Have all emergency exit and safety lights been checked?
*
Yes, all checked and operational
Some issues found (see above)
Submit Checklist
Should be Empty: