Hospital Infrastructure Resistance Testing Form
Document hospital infrastructure resistance testing activities with detailed technical information.
Test Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Hospital or Facility Name
*
Department or Area Tested
*
Infrastructure Asset or System Tested
*
Test Type
*
Please Select
Electrical Resistance
Load Test
Thermal Resistance
Structural Resistance
Other
Resistance/Load Test Parameters
*
Observed Results
*
Issues or Anomalies Found
Tester/Technician Name
*
Follow-up Actions or Recommendations
Submit Report
Should be Empty: