Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 2

ARCHIRODON GROUP NV Integrated Management System

Health, Safety & Environment (HSE) Rev. Issued For General Use Reference No. HSE-PRO-05-04 Serial No. Page 1 of 2 Position: Calibration Date:

FORM

0.0

Light Survey Report

Name Of Surveyor: Lux Meter Make & Serial:

Survey Methodology:

No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

Indoor Light Survey (LUX) Location Limit

Result

No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

Outdoor Light Survey (LUX) Location Limit

Result

Refer To Location Sketch of Survey Points on Page 2 Proposed Corrective / Preventive Action:

Note: Action Items to be transferred to HSE-PRO-05-F02 - Action Tracking and Recording Register

Completed by Job Position Name Surname Signature Date

Approved by Job Position Name Surname Signature Date HSE Manager

Distribution List Job Position Name Surname

ARCHIRODON GROUP NV Integrated Management System

Health, Safety & Environment (HSE) Rev. Issued For General Use Reference No. HSE-PRO-05-04 Serial No. Page 2 of 2

FORM

0.0

Light Survey Report

Location Sketch of Survey Points:

SKETCH INCLUDING ILLUMINATION MEASURE POINTS

You might also like