Run Emergency Call Light System Functional Test — Free

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 critical (required)

Yes No N/A

Bathroom call light activates when button or pull station is pressed critical (required)

Yes No N/A

Call light activation is audible and/or visible at the nurse station or annunciator critical (required)

Yes No N/A

Correct room or bathroom location is identified at the annunciator critical (required)

Yes No N/A

Call light resets properly after activation is cleared critical (required)

Yes No N/A

Dome Light and Annunciator Verification

Room dome light illuminates when the call light is activated critical (required)

Yes No N/A

Corridor or over-door indicator illuminates for the correct room critical (required)

Yes No N/A

Nurse station annunciator displays the correct location critical (required)

Yes No N/A

Annunciator tone or alert is distinct and recognizable to staff

Yes No N/A

Staff Response Verification

Staff responded to the call light within the facility target time critical (required)

Responding staff member identified themselves and addressed the request critical (required)

Yes No N/A

Response was documented or acknowledged per facility procedure

Yes No N/A

Any delayed or missed response was escalated to supervision

Yes No N/A

Deficiencies and Corrective Action

Any deficiency identified during the test

Yes No N/A

Deficiency description and affected location documented

Corrective action owner and due date assigned

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Run: Emergency Call Light System Functional Test

Inspection Details

Room and Bathroom Call Light Activation

Dome Light and Annunciator Verification

Staff Response Verification

Deficiencies and Corrective Action

Get your results