Record of technical safety inspection (for electric elevator)

RECORD OF TECHNICAL SAFETY INSPECTION FOR ELECTRIC ELEVATOR

RECORD OF TECHNICAL SAFETY INSPECTION

(FOR ELECTRIC ELEVATOR)

No. …

The participants include:

1………Inspector’s number: ………

1………Inspector’s number: ………

Inspection organization: ………

Inspection organization’s registered certificate number: ………

Name of the equipment inspected: ………

Name of the requester:

Address (head office):

Address (location) of equipment installation:

Inspection procedure and standards applied: ………

Individuals witnessing and ratifying the record: ………

1................................................... Position: ………

2................................................... Position: ………

I. PARAMETERS OF THE ELEVATOR

II. FORM OF INSPECTION

First time □ Periodic □ Random □

III. DETAILS OF INSPECTION:

1. DOCUMENT INSPECTION:

- Remark: ………

- Assessment of findings:

2. EXTERNAL INSPECTION:

- Remark: ………

Elevator completeness and synchronization: …

Defects and deformation: …

- Assessment of findings: Pass □ Fail □

3. TECHNICAL INSPECTION AND EMPTY LOAD TEST:

- Remark: ………

- Assessment of findings:

4. DYNAMIC TEST OF 100% RATED LOAD:

- Remark: ………

+ Instantaneous safety gear with or without buffered effect:

Result: Pass □ Fail □

5. DYNAMIC TEST OF 125% RATED LOAD:

- Remark: ………

- Remark: ………

- Assessment of findings:

+ Automatic rescue device (if available) Result: Pass □ Fail □

+ Communications system (bell, emergency phone)

Result: Pass □ Fail □

IV. CONCLUSION AND RECOMMENDATION

1. The elevator inspected is: Qualified □ Unqualified □

to operate with the maximum load of … (kg)2. Inspection stamp n^o … appended at …

3. Other recommendations (if any): …

Time limit for implementation of recommendations: …

V. INSPECTION SCHEDULE

The following inspection shall be scheduled for ... [date]

Reason for early inspection schedule (if applicable): …

The record was ratified on … [date]

At: …

The record is made into ... originals. Each party keep ... original(s)

The inspectors conducting the inspection of the elevator assume all liabilities for the accuracy of remarks and assessments in this record./.