Emergency Exit/Lighting Log

EMERGENCY AND EXIT LIGHTING LOG
30 SECONDS PER MONTH / 1 HOUR PER YEAR

THIS DOCUMENT SHOULD BE SECURELY ATTACHED TO THE WALL IN CLOSE PROXIMITY TO THE MAIN ELECTRICAL CIRCUIT BREAKER PANEL OR APPROPRIATE LIGHTING PANEL.

JANUARY

Settlement Date

Exit Signs Operational

Emergency Lights Operational

Tested By

Explain “No” & date repaired

FEBRUARY

Settlement Date

Exit Signs Operational

Emergency Lights Operational

Tested By

Explain “No” & date repaired

MARCH

Settlement Date

Exit Signs Operational

Emergency Lights Operational

Tested By

Explain “No” & date repaired

APRIL

Settlement Date

Exit Signs Operational

Emergency Lights Operational

Tested By

Explain “No” & date repaired

MAY

Settlement Date

Exit Signs Operational

Emergency Lights Operational

Tested By

Explain “No” & date repaired

JUNE

Settlement Date

Exit Signs Operational

Emergency Lights Operational

Tested By

Explain “No” & date repaired

JULY

Settlement Date

Exit Signs Operational

Emergency Lights Operational

Tested By

Explain “No” & date repaired

AUGUST

Settlement Date

Exit Signs Operational

Emergency Lights Operational

Tested By

Explain “No” & date repaired

SEPTEMBER

Settlement Date

Exit Signs Operational

Emergency Lights Operational

Tested By

Explain “No” & date repaired

OCTOBER

Settlement Date

Exit Signs Operational

Emergency Lights Operational

Tested By

Explain “No” & date repaired

NOVEMBER

Settlement Date

Exit Signs Operational

Emergency Lights Operational

Tested By

Explain “No” & date repaired

DECEMBER

Settlement Date

Exit Signs Operational

Emergency Lights Operational

Tested By

Explain “No” & date repaired

THE ONE (1) HOUR ANNUAL TESTING OF THE EMERGENCY LIGHTING SYSTEM WAS CONDUCTED ON

CONDUCTED BY (print name/position)

DID ALL EMERGENCY AND EXIT LIGHTING FUNCTION FOR THE DURATION OF THE TEST ?

Yes No

IF NO, LIST PROBLEM(S) BELOW.

DEFICIENCIES FROM ANNUAL TEST CORRECTED ON

Name

Phone

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