Title Page

  • Site conducted
  • Conducted on

  • Prepared by

Lift Information

  • Lift Type and Description

  • Lift ID Number

  • Manufacturers Serial Number

  • Lift Location

  • Signed

  • Name

  • Position

A.8 Governor Operated Safety Gear - Instantaneous

  • Where documented evidence exists (signed test document) that the
    safety gear system met the requirements current at the time of
    installation, modification, replacement or refurbishment, a rated speed
    empty car test should be conducted for car and any counterweight
    safety gear. The objective of the test, is to ensure the correct operation
    of the overspeed governor and safety gear system and to ensure fittings
    within the car remain secure, ropes do not leave sheaves and filler
    weights in counterweight frames do not become displaced.
    Where there is no documented evidence of a previous successful test (with
    a rated load for car, empty car for counterweight) a test should be performed
    to prove the system operates in accordance with the requirements specified
    in the standard applicable at the time of installation. When conducting the
    test the method should ensure the lift is stopped by the safety gear without
    the assistance of the brake or some other device. Any testing of these
    devices should be done by referencing the OEM manuals for guidance to
    minimise any potential wear or damage. The aim of this test is to check the
    correct mounting, correct setting and the soundness of the complete
    assembly, comprising car, safety gear, guide rails and their fixing to the
    building. The test should also ensure that the safety gear and car frame
    are capable of absorbing the loads imposed on them.

    A visual check will be carried out by the Competent Person during the
    thorough examination and further regular visual checks of the system
    should be carried out by the maintenance company but it is
    recommended that this be included as a periodic test at 10 year intervals
    unless there is evidence to suggest more frequent testing is required.


    After any such supplementary test, it should be ascertained that no
    deterioration, which could adversely affect the normal use of the lift,
    has occurred. If necessary, friction components should be replaced.

  • Indicate car or counterweight

  • Safety gear type and/or referance

  • Are all linkages and moving parts free of any defects, deterioration or wear that may prevent their free and effective operation?

  • Are the surfaces of any friction elements free of any abnormal or excessive wear that may prevent free and effective operation of the safety gear system?

  • Does the safety gear mechanism move freely and engage the guide rails satisfactorily?

  • If NO, explain

Dynamic Test Conditions (where appropriate)

  • Load in car? (kg)

  • Speed at activation? (m/s)

  • How was the system tested?

  • Comments and observations

  • Did the safety gear operate and stop the car as required?

  • If NO, explain

  • Does the result of the supplementary test(s) indicate further remedial work is necessary?

  • If YES, state your recommendations(s) for further action required

A.9 Governor Operated Safety Gear - Progressive Type

  • Where documented evidence exists (signed test document) that the
    safety gear system has been tested and met the requirements current at
    the time of installation, modification, replacement or refurbishment, a
    reduced speed (approximately 1m/s) empty car test should be
    conducted for car and any counterweight safety gear. When
    conducting the test the method should ensure the lift is stopped by the
    safety gear without the assistance of the brake or some other device.
    Any testing of these devices should be done by referencing the OEM
    manuals for guidance to minimise any potential wear or damage. The
    objective of the test, is to ensure the correct operation of the overspeed
    governor and the safety gear system and to ensure fittings within the car
    remain secure, ropes do not leave sheaves and filler weights in
    counterweight frames do not become displaced.
    Where there is no documented evidence of a previous successful test (in
    accordance with requirements current at the time of installation) a test
    should be performed to prove the system operates in accordance with
    the standard applicable at the time of installation. The aim of this test is
    to check the correct mounting, correct setting and the soundness of the
    complete assembly, comprising car, safety gear, guide rails and their
    fixing to the building. The test should also ensure that the safety gear and
    car frame are capable of absorbing the loads imposed on them.

    A visual check will be carried out by the Competent Person during the
    thorough examination and further regular visual checks of the system
    should be carried out by the maintenance company but it is
    recommended that this be included as a periodic test at 10 year intervals
    unless there is evidence to suggest more frequent testing is required.
    After the test, it should be ascertained that no deterioration which could
    adversely affect the normal use of the lift has occurred. If necessary,
    friction components may be replaced.

  • Indicate car or counterweight

  • Safety gear type and/or referance

  • Are all linkages and moving parts free of any defects, deterioration or wear that may prevent their free and effective operation?

  • Are the surfaces of any friction elements free of any abnormal or excessive wear that may prevent free and effective operation of the safety gear system?

  • Does the safety gear mechanism move freely and engage the guide rails satisfactorily?

  • If NO, explain

Dynamic Test Conditions (where appropriate)

  • Load in car? (kg)

  • Speed at activation? (m/s)

  • Did the safety gear operate and stop the car as required?

  • If NO, explain

  • How was the system tested?

  • Does the result of the supplementary test(s) indicate further remedial work is necessary?

  • If YES, state your recommendations(s) for further action required

A.10 Safety Gear Operated By Other Means

  • Some types of safety gears operate only on failure or slackening of the
    main suspension system. Where documented evidence exists (signed
    test document) that the safety gear system met the requirements current
    at the time of installation, modification, replacement or refurbishment,
    a rated speed empty car test should be conducted for car and any
    counterweight safety gear. The objective of the test, is to ensure the
    correct operation of the safety gear system and to ensure fittings within
    the car remain secure, ropes do not leave sheaves and filler weights in
    counterweight frames do not become displaced.
    Where there is no documented evidence of a previous successful test
    (with a rated load for car, empty car for counterweight) a test should be
    performed to prove the system operates in accordance with the
    requirements specified in the standard applicable at the time of
    installation. When conducting the test the method should ensure the lift
    is stopped by the safety gear without the assistance of the brake or
    some other device. Any testing of these devices should be done by
    referencing the OEM manuals for guidance to minimise any potential
    wear or damage. The aim of this test is to check the correct mounting,
    correct setting and the soundness of the complete assembly, comprising
    car, safety gear, guide rails and their fixing to the building. The test
    should also ensure that the safety gear and car frame are capable of
    absorbing the loads imposed on them.

    A visual check will be carried out by the Competent Person during the
    thorough examination and further regular visual checks of the system
    should be carried out by the maintenance company but it is
    recommended that this be included as a periodic test at 10 year intervals
    unless there is evidence to suggest more frequent testing is required.
    After any such supplementary test, it should be ascertained that no
    deterioration, which could adversely affect the normal use of the lift,
    has occurred. If necessary, friction components should be replaced.

  • Indicate car or counterweight

  • Safety gear type and/or referance

  • Are all linkages and moving parts free of any defects, deterioration or wear that may prevent their free and effective operation?

  • Are the surfaces of any friction elements free of any abnormal or excessive wear that may prevent free and effective operation of the safety gear system?

  • Does the safety gear mechanism move freely and engage the guide rails satisfactorily?

  • If NO, explain

Dynamic Test Conditions (where appropriate)

  • Load in car? (kg)

  • Speed at activation? (m/s)

  • How was the safety gear tested?

  • State the stopping distance (progressive type only mm)

  • Does the safety gear stop the car or counterweight in the downward direction during dynamic testing?

  • Was the floor of the lift car less than 5° to the horizontal after the safety gear activated and before it is released?

  • After the test, confirm that no deterioration has occurred that could adversely affect the safety of the lift and correct operation of the safety gear system

  • * Some safety gear systems (slack rope type) may not be possible to operate. In such circumstances indicate that a dynamic test has not been made and describe in detail what has been inspected, the condition of the device, the probability of successful operation and why it could not be operated.

  • If No, Explain

  • Does the result of the supplementary test(s) indicate further remedial work is necessary?

  • If YES, state your recommendations(s) for further action required

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.