Emergency Call Light System Functional Test

Periodic inspection template for testing every room and bathroom call light, including activation, dome light/annunciator operation, and staff response verification.

Inspection Details

• Inspection date and time recorded
• Inspector name and role documented
• Unit, wing, or floor identified
• Test type selected
• Reference procedure or maintenance log noted

Room and Bathroom Call Light Activation

• Room call light activates when button or pull station is pressed
• Bathroom call light activates when button or pull station is pressed
• Call light activation is audible and/or visible at the nurse station or annunciator
• Correct room or bathroom location is identified at the annunciator
• Call light resets properly after activation is cleared

Dome Light and Annunciator Verification

• Room dome light illuminates when the call light is activated
• Corridor or over-door indicator illuminates for the correct room
• Nurse station annunciator displays the correct location
• Annunciator tone or alert is distinct and recognizable to staff

Staff Response Verification

• Staff responded to the call light within the facility target time
• Responding staff member identified themselves and addressed the request
• Response was documented or acknowledged per facility procedure
• Any delayed or missed response was escalated to supervision

Deficiencies and Corrective Action

• Any deficiency identified during the test
• Deficiency description and affected location documented
• Corrective action owner and due date assigned