AMIBASE (PTY) LTD

Lighting Checklist
Form 1.1b Rev 0

Location:

Date Inspected

1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

No Question
Yes No Yes No Yes No Yes No

1 Are all lights working

2 Lights clean

3 Guards and holders in place

4 Is there adequate lighting

5 Is there reflection on work places

6 Are switches in good working order

7 Are windows clean

8 External Light Intensity Report Available

Inspectors Name

Inspectors Signature

Any defects are to be reported onto Form 14-Sa – Deviation Report by the responsible nominated person.