Lighting Fixture Inspection Form
Document the inspection and condition of lighting fixtures in your facility.
Inspection Date
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Inspector Name
*
First Name
Last Name
Location of Fixture
*
Fixture Identification Number or Code
*
Type of Lighting Fixture
*
Please Select
LED
Fluorescent
Incandescent
Halogen
Other
Operational Status
*
Working
Not Working
Intermittent
Physical Condition
*
Good
Minor Damage
Major Damage
Safety Compliance
*
Compliant
Non-Compliant
Needs Further Review
Issues Found
Burnt-out bulb
Loose wiring
Broken fixture
Flickering
Other
Actions Taken
Replaced bulb
Repaired wiring
Fixture replaced
No action required
Other
Upload Photos of Fixture (if applicable)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Additional Comments or Recommendations
Inspector Signature
*
Submit Inspection
Submit Inspection
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