Residential Lighting Inspection Form

Name (*required)

Email *

Address *

City *

State *

Zip *

Location 1 *

Task in the area: *

Dimmable? *
Yes No

Bulb you are using now: *

Hours used per day: *

Is it left on or switched on and off a lot? *
Left On Switched On/Off a lot

Are you pleased with the light level? *
Yes No

Are you pleased with the color? *
Yes No

Comments:

Location 2 *

Task in the area: *

Dimmable? *
Yes No

Bulb you are using now: *

Hours used per day: *

Is it left on or switched on and off a lot? *
Left On Switched On/Off a lot

Are you pleased with the light level? *
Yes No

Are you pleased with the color? *
Yes No

Comments:

Location 3 *

Task in the area: *

Dimmable? *
Yes No

Bulb you are using now: *

Hours used per day: *

Is it left on or switched on and off a lot? *
Left On Switched On/Off a lot

Are you pleased with the light level? *
Yes No

Are you pleased with the color? *
Yes No

Comments:

Additional Comments

8:30 - 5:00 p.m
Monday - Friday
Phone: 719-632-2670

Toll Free: 1-800-554-2852
Fax: 719-632-8937

2324 E Bijou St.
Colorado Springs, Co 80909
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