High-Intensity Discharge Ballast Inspection Form
Complete this form to document inspection details, operational status, and observations for HID ballasts at your facility.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Facility / Location
*
Fixture or Ballast ID / Asset Tag
*
Ballast Type / Lamp Type
*
Please Select
Metal Halide
High Pressure Sodium
Mercury Vapor
Low Pressure Sodium
Other
Operational Status
*
Please Select
Functioning
Flickering
Intermittent
Failed
Other
Physical Condition / Visible Damage Notes
*
Temperature or Overheating Observation
*
Please Select
Normal
Warm
Hot
Overheating
Unable to assess
Was a safety issue observed?
*
Yes
No
Additional Comments / Recommended Action
Submit Inspection
Should be Empty: