Title Page

  • Site conducted

  • Site conducted

  • Conducted on

  • Prepared by

  • Manufacturer

  • Model

  • Type of lift

  • Rated load

Motor room

  • Clean and Tidy

  • Electrical wiring diagrams present?

  • Thumbtag on door lock

  • Motor room lighting

  • Emergency light

  • Signage

  • Barrier

  • Rubber mat

  • Fire extinguisher

  • Hand winding unit

Hydraulics

  • Location

  • Ram action

  • Valve type

  • Visible leaks

  • Holding pressure

  • Ram information

  • Does lift strike overtravel limit before RAM collars?

Traction System

  • Location

  • Manufacturer

  • Type

  • Number of ropes

  • Rope size

  • Roping arrangement

  • Overrun clearance satisfactory?

Lift shaft

  • Clean

  • Shaft lighting

  • lift pit

  • Car top

  • Car top stop within 1m of entrance

  • Handrails

  • Shaft position system type

Lift car

  • Clean

  • COP

  • Car lighting

  • Emergency lighting

  • Car alarm

  • Alarm under loss of power

  • Autodialler

  • Door gear

  • Door gear condition

  • Car doors

  • Hanging rollers

  • Door shoes

  • Landing door picks

  • Landing door hanging rollers

  • Guide shoes/Rollers

Photos

  • Add media

  • Add media

  • Add media

  • Add media

  • Add media

  • Add media

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.