High Mast Lighting Survey Form
Please complete this survey to evaluate the condition and performance of high mast lighting installations.
Installation Location (Address or Description)
*
Type of High Mast Installation
*
Sports Facility
Highway/Interchange
Parking Lot
Industrial Area
Other
Number of Light Fixtures on Mast
*
Lamp Type Used
*
LED
Metal Halide
High Pressure Sodium
Other
Pole Height (in meters)
*
Fixture Condition
*
Excellent
Good
Fair
Poor
Operational Status
*
All Fixtures Working
Some Fixtures Out
All Fixtures Out
Rate the Quality of Light Output
*
1
2
3
4
5
Maintenance Needs (select all that apply)
Lamp Replacement
Fixture Cleaning
Structural Repair
Electrical Repair
Other
Additional Comments or Observations
Submit Survey
Should be Empty: