Emergency Lighting Certificate Form PDF Details

If you are a business owner, it is important to understand the different types of emergency lighting certificates that are available. A certificate of occupancy (CO) is a document that states that a property has been constructed or altered in accordance with the applicable building codes and is safe for use. There are three different types of COs: temporary, preliminary, and final. A temporary CO is valid for up to 180 days and can be used while a permanent CO is being processed. A preliminary CO is valid for up to 12 months and allows the use of a property while construction or alterations are completed. A final CO is issued after all work has been completed and/or inspected and authorizes full use of the property. There are also three types of emergency lighting certificates: shelter-in-place, evacuation, and both. It is important to have the correct type of emergency lighting certificate for your business to ensure compliance with local fire codes. To learn more about emergency l

QuestionAnswer
Form NameEmergency Lighting Certificate Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesemergency lighting test sheet pdf, emergency lighting installation certificate, emergency light test certificate, emergency lighting certificate template

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EM ERGEN CY LI GH TI N G PERI ODI C I N SPECTI ON AN D

Cer t ificat e Refer ence:

 

 

 

 

TESTI N G CERTI FI CATE

 

 

 

 

 

 

D ETAI LS OF TH E CLI EN T

 

 

Client :

 

 

 

 

 

 

 

Addr ess:

 

 

 

 

 

 

D ETAI LS OF TH E EM ERGEN CY LI GH TI N G I N STALLATI ON

I nst allat ion

Addr ess:

Ex t ent of t he

inst allat ion cov er ed by t his cer t ificat e:

Pur pose of Cer t ificat e

To cer t ify cont inued com pliance of an ex ist ing inst allat ion:

D ETAI LS OF TH E ELECTRI CAL CON TRACTOR

Tr ading Tit le:

Addr ess:

Regist r at ion Num ber :

Telephone Num ber :

Post code:

I / w e her eby cer t ify t hat t he em er gency light ing sy st em inst allat ion at t he abov e pr em ises has been inspect ed and t est ed by m e/ us in accor dance w it h t he 'Result s Schedule of it em s inspect ed and t est ed' on page 2, and t o t he best of m y / our k now ledge and belief, t he inst allat ion com plies at t he t im e of m y / our inspect ion and t est ing w it h t he r ecom m endat ions giv en in BS 5266 - 1: 2005

Em er gency light ing Par t 1: Code of pr act ice for t he em er gency light ing of pr em ises, BS EN 1838: 1999 / BS 5266 - 7: 1999 Light ing

applicat ions - Em er gency light ing and BS EN 50172: 2004 / BS 5266 - 8: 2004 Em er gency escape light ing sy st em s, ex cept as st at ed in t he dev iat ions below .

Nam e:

 

Posit ion:

 

Signat ur e:

 

Dat e:

 

 

 

 

 

 

 

D ETAI LS OF D EVI ATI ON S FROM TH E CURREN T STAN D ARD S

Re qu ire m e n t N o

De t a ils of de via t ion

( I f necessar y r ecor d addit ional dev iat ions on a separ at e sheet )

RELATED REFEREN CE D OCUM EN TS

Per iodic I nspect ion Repor t No. and/ or dat e of m ost r ecent - cov er ing t he ex ist ing em er gency light ing inst allat ion ( Not e 1) .

Ot her docum ent s ( if any ) please st at e:

N EXT I N SPECTI ON

I / We, t he per son ident ified in C, RECOMMEND t hat t his inst allat ion is fur t her inspect ed and t est ed aft er an int er v al of not m or e t han:

I nt erval i n accordance w i t h Cl ause 7. 2 of BS EN 50172: 2004 / BS 5266- 8: 2004

Not es: 1. The w i ri ng syst em of an exi st i ng em ergency l i ght i ng syst em shoul d have been peri odi cal l y i nspect ed and t est ed i n accordance w i t h BS 7671 and a Peri odi c I nspect i on Report i ssued. Where appl i cabl e and w here avai l abl e, t he seri al num ber and/ or dat e of t he m ost recent report shoul d be recorded i n t he space provi ded.

This for m is based on t he m odel show n in Annex D of BS 5266: Par t 1: 2005

Page: 1 of 2

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PURPOSE OF I N STALLED EM ERGEN CY LI GH TI N G SYSTEM

Em er gency escape light ing

 

St andby light ing

Escape r out e light ing

 

Par t ial st andby light ing

 

 

Open ar ea light ing

 

High r isk t ask ar ea light ing

 

 

 

 

 

EM ERGEN CY LI GH TI N G I N STALLATI ON ARRAN GEM EN T

Self - cont ained em er gency lum inair e

 

Com bined em er gency lum inair e

Cent r al bat t er y sy st em

 

St andby gener at or sy st em

 

 

 

 

 

EM ERGEN CY LI GH TI N G I N STALLATI ON ARRAN GEM EN T

Typ e

M od e

Fa cilit ie s

D u r a t ion

EM ERGEN CY LI GH TI N G I N STALLATI ON ARRAN GEM EN T

 

I f 'No', t he dev iat ion w ill be r ecor ded on Page 1

 

 

 

 

 

 

 

 

BS 5 2 6 6 - 1

 

 

 

 

Syst e m Con form s

cla u se

 

Re qu ire m e n t s

 

 

 

 

 

 

re fe re n ce

 

 

 

 

Ye s

N o

N / A

 

 

 

 

 

 

 

 

4

.2

P1 -

Plans ar e av ailable and cor r ect

 

 

 

 

 

 

 

 

 

 

Cla u se 6

P2 -

Under t est condit ions, adequat e* * illum inat ion pr ov ided for safe m ov em ent on t he escape

 

 

 

 

 

r out e and t he open ar eas

 

 

 

 

 

 

 

 

 

 

 

6

.3

P3 -

Lum inair es cor r ect ly posit ioned and or ient ed as show n on t he plans

 

 

 

 

 

 

 

 

 

 

 

6

.3

P4 -

Or iginal design st ill v alid

 

 

 

 

 

 

 

 

 

 

 

6

.6

P5 -

All escape r out e safet y signs and fir e fight ing equipm ent locat ion signs v isible w it h t he

 

 

 

 

 

nor m al light ing ex t inguished

 

 

 

 

 

 

 

 

 

 

 

 

7

.8

P6 -

Cor r ect applicat ion and sit ing of addit ional em er gency light ing

 

 

 

 

 

 

 

 

 

 

 

 

7

.9

F7 -

Lum inair es confor m t o BS EN 60598 - 2 - 22

 

 

 

 

 

 

 

 

 

 

 

7

.9

F8 -

Lum inair es hav e an appr opr iat e I ngr ess Pr ot ect ion r at ing for t heir locat ion, as specified in

 

 

 

 

 

t he sy st em design

 

 

 

 

 

 

 

 

 

 

 

 

9

.1

P9 -

Wir ing sy st em s com ply w it h t he r equir em ent s if BS 7671

 

 

 

 

 

 

 

 

 

 

 

 

9

.2

P10 -

Fir e pr ot ect ion of cent r al w ir ing sy st em s sat isfact or y

 

 

 

 

 

 

 

 

 

 

 

 

9

.2 .5

P11 -

Em er gency cir cuit s cor r ect ly segr egat ed fr om ot her supplies

 

 

 

 

 

 

 

 

 

 

 

9

.2 .1 2

P12 -

Wir ing t o em er gency light ing supply pow er sour ces a fix ed inst allat ion, w her e a specialist

 

 

 

 

 

plug and sock et ar r angem ent is used, it is pr ot ect ed against unaut hor ised int er fer ence

 

 

 

 

 

 

 

 

 

 

 

9

.3 .3

P13 -

Sy st em has a suit able t est facilit y for t he applicat ion

 

 

 

 

 

 

 

 

 

 

 

9

.3 .5

P14 -

Cent r al pow er sy st em out put v olt age r ange is com pat ible w it h t he supply v olt age r ange of

 

 

 

 

 

t he lum inair es, t ak ing int o account supply cable v olt age dr op

 

 

 

 

 

 

 

 

 

 

 

1

0 .1

P15 -

Lum inair es t est ed and found t o oper at e for t heir full r at ed dur at ion

 

 

 

 

 

 

 

 

 

 

 

1

1 .6

P16 -

Oper at ion and m aint enance

 

 

 

 

 

 

 

 

 

 

 

 

1

2

P17 -

Test r ecor ds in t he log book com plet e and sat isfact or y

 

 

 

 

 

 

 

 

 

 

 

1

2 .3

P18 -

I nst r uct ions t oget her w it h a suit able log book show ing a sat isfact or y com m issioning t est

 

 

 

 

 

av ailable for use by t he building occupier

 

 

 

 

 

 

 

 

 

 

 

 

1

3

P19 -

Lum inair es clean and undam aged w it h lam ps in good condit ion

 

 

 

 

 

 

 

 

 

 

 

1

3

P20 -

Building occupier and t heir st aff t r ained on suit able m aint enance, t est ing and oper at ing

 

 

 

 

 

pr ocedur es, or a cur r ent m aint enance cont r act is in place

 

 

 

 

 

 

 

 

 

 

 

 

 

13 .2

13 .3

P21 - Ev idence of ser v icing of Cent r al Bat t er y Sy st em ( in line w it h m anufact ur er 's pr ocedur es) ; in - house or cur r ent m aint enance cont r act is in place

P22 - Ev idence of ser v icing of St andby Gener at or Sy st em ( in line w it h m anufact ur er 's pr ocedur es) ; in - house or cur r ent m aint enance cont r act is in place

1 3 .4

P23 - Aft er t est , t he char ging indicat or s oper at e cor r ect ly

* * This can be check ed by v isual inspect ion and check ing t hat t he illum inat ion fr om t he lum inair es is not obscur ed and t hat m inim um design spacings hav e been m et .

TEST I N STRUM EN TS USED

I nst r um ent 1 ( Light Met er ) Model:

 

Ser ial Num ber :

 

I nst r um ent 2 ( I f Any ) Model:

 

Ser ial Num ber :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This for m is based on t he m odel show n in Annex D of BS 5266: Par t 1: 2005

Refer ence: _______________

Page: 2 of 2

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Tips on how to complete emergency lighting periodic inspection and testing certificate stage 1

2. Immediately after the first part is filled out, go on to type in the relevant information in all these - Telephone Num ber, Post code, I w e hereby cert ify t hat t he, Nam e, Posit ion, Signat ure, Dat e, DETAI LS OF DEVI ATI ON S FROM THE, Requirem ent N o, Det ails of deviat ion I f, RELATED REFEREN CE DOCUMEN TS, and Ot her docum ent s if any please.

Writing segment 2 of emergency lighting periodic inspection and testing certificate

3. The following part will be focused on N EXT I N SPECTI ON I We t he, Not es The w iring syst em of an, This form is based on t he m odel, Page of, I nt erval in accordance w it h, and You created this PDF from an - complete each of these fields.

emergency lighting periodic inspection and testing certificate conclusion process outlined (portion 3)

4. You're ready to fill in this fourth segment! Here you'll get all of these PURPOSE OF I N STALLED EMERGEN CY, Em ergency escape light ing, Escape rout e light ing, Open area light ing, St andby light ing, Part ial st andby light ing, High risk t ask area light ing, EMERGEN CY LI GHTI N G I N, Self cont ained em ergency lum, Com bined em ergency lum inaire, Cent ral bat t ery sy st em, St andby generat or sy st em, EMERGEN CY LI GHTI N G I N, Type, and Mode blank fields to complete.

EMERGEN CY LI GHTI N G I N, EMERGEN CY LI GHTI N G I N, and Part ial st andby light ing in emergency lighting periodic inspection and testing certificate

5. To conclude your form, the last segment involves a few extra blank fields. Completing P All escape rout e safet y signs, P Correct applicat ion and sit ing, F Lum inaires conform t o BS EN, F Lum inaires hav e an appropriat, P Wiring sy st em s com ply w it h, P Fire prot ect ion of cent ral w, P Em ergency circuit s correct ly, P Wiring t o em ergency light ing, P Sy st em has a suit able t est, P Cent ral pow er sy st em out put, P Lum inaires t est ed and found t, P Operat ion and m aint enance, P Test records in t he log book, P I nst ruct ions t oget her w it, and P Lum inaires clean and undam aged will finalize everything and you will be done in an instant!

emergency lighting periodic inspection and testing certificate conclusion process clarified (portion 5)

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