EMERUS MONTHLY ELEVATOR SURVEY

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Elevators Safety Inspection

• Facility ?

• Address of location ?
  Address

• Inspection performed by ?

• Date of inspection ?

  Date

• Are certificates framed and on display ?

  Yes

  No

  N/A

• Is certification current and up to date ?

  Yes

  No

  N/A

Elevator #1 Safety Inspection

• Is elevator functioning and in use ?

  Yes

  No

  N/A

• Are the lights in elevator working ?

  Yes

  No

  N/A

• Is the exhaust fan in elevator working ?

  Yes

  No

  N/A

• Is the door safeties working properly ?

  Yes

  No

  N/A

• Are the door tracks and guides free and clear of debris ?

  Yes

  No

  N/A

• Is elevator car clean and free of debris ?

  Yes

  No

  N/A

• Was the emergency phone activated and contact made ?

  Yes

  No

  N/A

• Was elevator placed in fire mode and test performed ?

  Yes

  No

  N/A

• Did elevator return to the first floor ?

  Yes

  No

  N/A

• Was elevator reset and placed back in service ?

  Yes

  No

  N/A

Elevator #2 Safety Inspection

• Is elevator functioning and in use ?

  Yes

  No

  N/A

• Is the exhaust fan in elevator working ?

  Yes

  No

  N/A

• Is the door safeties working ?

  Yes

  No

  N/A

• Are the door tracks and guides free and clear of debris ?

  Yes

  No

  N/A

• Is the elevator car free and clear of debris ?

  Yes

  No

  N/A

• Was the emergency phone activated and contact made ?

  Yes

  No

  N/A

• Was elevator placed in fire mode and test performed ?

  Yes

  No

  N/A

• Did elevator return to first floor ?

  Yes

  No

  N/A

• Was elevator reset and placed back in service ?

  Yes

  No

  N/A

Elevator #3 Safety Inspection

• Is elevator functioning and in use ?

  Yes

  No

  N/A

• Is exhaust fan in elevator working ?

  Yes

  No

  N/A

• Is the door safeties working ?

  Yes

  No

  N/A

• Are the door tracks and guides free and clear of debris ?

  Yes

  No

  N/A

• Is the elevator car free and clear of debris ?

  Yes

  No

  N/A

• Was the emergency phone activated and contact made ?

  Yes

  No

  N/A

• Was elevator placed in fire mode and test performed ?

  Yes

  No

  N/A

• Did elevator return to first floor?

  Yes

  No

  N/A

• Was elevator reset and placed back in service?

  Yes

  No

  N/A