Title Page

  • Site conducted

  • Building Name

  • Conducted on

  • inspected by

  • Location
  • Lift Number

Mobilisation Works (as applicable)

  • Original Lift Equipment Removed

  • Lift well scaffolding Installed?

  • Temporary lighting Installed?

  • Lockable hoardings Fitted?

  • lift entrance secondary barriers Fitted?

  • Lifting beams / eyes installed and tested

  • Warning signage fitted

  • Additional Notes / Observations

Health & Safety

  • Operatives wearing correct PPE?

  • All required inductions undertaken by on site personnel?

  • Required Construction Phase Plan held on site?

  • First Aid kit held on site (if applicable)?

  • Additional Notes / Observations

New Equipment Installation (as applicable)

  • Guide Rails (Car / Counterweight)

  • Lift Sling

  • Lift Car body

  • Counterweight frame & Filler Weights

  • Counterweight Safety Gear

  • Counterweight Guarding

  • Machine Room Electrical (if applicable)

  • Machine Room Lighting (if applicable)

  • Control System

  • Hoist Machine

  • Lift Suspension

  • Overspeed Governor, Rope & Pulley

  • Lift Car Guide Shoes / Rollers

  • Car Top Engineers Control

  • Car top Balustrade / Guarding

  • Lift Well Wiring

  • Lift Well Switching

  • Lift Well Lighting

  • Landing Entrances

  • Landing Buttons

  • Landing Signalisation

  • Car Interior Finishes

  • Car Operations Panel

  • Car Doors

  • Car Door Operating System

  • Car Safety Gear

  • Lift Pit Wiring

  • Car and Counterweight Buffers

  • Autodialler & GSM (if applicable)

  • Elevator Monitoring System

  • Firefighters Lift Provisions

  • Special Features (Provide Details)

  • Lift Testing & Commissioning

  • Lift Car Ride Quality Measurements

  • Additional Notes / Observations

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.