Emergency Lighting Risk Assessment Form
Complete this form to record emergency lighting conditions, identify risks, and capture any corrective actions needed.
Site and Assessment Details
Site / Building Name
*
Exact Location or Area Assessed
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name or Role
*
Emergency Lighting Zone or Floor
*
Emergency Lighting Condition Review
Emergency lights present in key areas?
*
Yes
No
Partial
Not observed
Coverage along exit routes
*
1
2
3
4
5
Units illuminate correctly during test?
*
Yes
No
Partially
Not tested
Observed issues
Failed lamps
Damaged fittings
Blocked fixtures
Obscured signs
Inadequate coverage
Unclear escape-route lighting
Other
Last inspection or recent test date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Risk Rating and Corrective Actions
Overall Risk Level
*
Low
Medium
High
Critical
Main Hazards or Deficiencies Found
*
Immediate Corrective Actions Required
*
Responsible Person / Team
*
First Name
Last Name
Follow-up Due Date / Target Reinspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Assessment
Should be Empty: