Surgical Exam Light Inspection Checklist Form
Complete this Surgical Exam Light Inspection Checklist Form to document inspection details and ensure proper functionality and maintenance.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Surgical Exam Light Identifier/Location
*
Inspection Type
*
Routine
Post-maintenance
Pre-use
Other
Light Condition and Functionality
*
Lamp powers on/off correctly
No flickering or dimming
All bulbs/LEDs operational
Other (specify below)
Illumination Performance
*
Satisfactory
Needs adjustment
Unsatisfactory
Controls and Adjustability
*
All controls operate smoothly
Positioning arms lock and release properly
No unusual noise or resistance
Other (specify below)
Cleanliness and Damage Status
*
No visible dirt or debris
No cracks or damage to casing
Lens is clear and intact
Other (specify below)
Issues Found (if any)
Follow-up Actions / Notes
Submit Inspection
Should be Empty: