Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

EQUIPMENT DETAILS

  • EQUIPMENT:

  • EQUIPMENT NUMBER & GENERAL DETAILS

  • DATE OF LAST INSURANCE INSPECTION

  • DETAILS OF ANY INSURANCE ISSUES

  • MAINTENANCE CONTRACTOR

  • DATE OF LAST SERVICE VISIT

  • HAVE MAINTENANCE VISITS BEEN TO SCHEDULE

  • SUMMARY OF CALL OUTS ON LOG CARD

  • IS LG CERTIFICATION ON SITE

  • CONTRACT TYPE

  • REASON FOR AUDIT

MOTOR ROOM

  • IS ACCESS SAFE

  • PHOTO

  • CONDITION OF MAIN GEAR/HYDRAULICS

  • PHOTO

  • CONTROLLER REVIEW

  • PHOTO

  • ANY OTHER COMMENTS

  • PICTURE OF MOTOR ROOM

LIFT CAR

  • OPERATION/CONDITION OF CAR DOORS/GATES

  • PHOTO

  • LIGHTING LEVEL/CONDITION IN CAR

  • DO ALL BUTTONS AND INDICATORS WORK CORRECTLY

  • PHOTO

  • OPERATION OF CAR ALARM

  • CONDITION OF CAR FLOORING

  • PHOTO OF FLOORING

  • GENERAL COMMENTS

  • PICTURE OF LIFT CAR

  • DDA COMPLIANCE

LANDINGS

  • CONDITION OF DOORS/GATES AT BASEMENT LEVEL

  • CONDITION OF DOORS/GATES AT GROUND FLOOR

  • CONDITION OF DOORS/GATES AT FIRST FLOOR

  • CONDITION OF DOORS/GATES AT SECOND FLOOR

  • CONDITION OF DOORS/GATES AT THIRD FLOOR

  • CONDITION OF DOORS/GATES AT FOURTH FLOOR

  • CONDITION OF DOORS/GATES AT ALL OTHER FLOORS

  • DO ALL BUTTONS AND INDICATORS WORK CORRECTLY

  • PHOTO DOOR/GATE ISSUES

  • LANDING INDICATORS

  • CONDITION OF LOCKS AND ASSOCIATED EQUIPMENT( RAMPS, CATCHES, SWITCHES)

  • PHOTO

  • GENERAL COMMENTS/ENTRANCE SIZE

  • PICTURE OF ANY LANDING ISSUES

LIFT SHAFT

  • ANY H&S ISSUES ASSOCIATED WITH PIT (LADDER, PIT SWITCH, SHALLOW PIT, ETC)

  • CAR TOP CONTROL/CAR TOP ACCESS

  • ANY HAZARDS IN SHAFT

  • SHAFT LIGHTING

  • GENERAL COMMENTS

  • PICTURE OF ANY SHAFT ISSUES

OPERATIONAL REVIEW

  • HOW DOES LIFT OPERATE

  • HAVE INSURANCE ITEMS BEEN ACTIONED IN TIMELY MANNER

  • ANY LEVELLING ISSUES

  • PATIENT CARE ISSUES

  • PHOTO

  • RESPONSE TO CALL OUTS

  • ANY HEALTH & SAFETY ISSUES THAT NEED ADDRESSING

  • PHOTO

  • TIMESCALES FOR RESOLUTION OF HEATH & SAFETY ISSUES

  • IMPROVEMENTS/ACTIONS REQUIRED

  • PHOTO

  • TIMESCALES FOR RESOLUTION OF GENERAL ITEMS (LOW RISK)

MAINTENANCE CONTRACTOR REVIEW

  • Maintenance Quality - MACHINE ROOM (10=Max - 1=unacceptable)

  • Maintenance Quality - LIFT CAR (10=Max - 1=unacceptable)

  • Maintenance Quality - CAR & LANDING GATES/DOORS (10=Max - 1=unacceptable)

  • Maintenance Quality - SHAFT (10=Max - 1=unacceptable)

  • Maintenance Quality - PIT (10=Max - 1=unacceptable)

  • PERFORMANCE OF CONTRACTOR (CLIENT OPINION - ADDITIONAL COMMENTS)

  • Maintenance Quality - OVERALL SCORE (10=Max - 1=unacceptable)

EQUIPMENT OVERALL REVIEW BY SCORE

  • AGE OF EQUIPMENT:

  • call outs in last 24 MONTHS

  • RELIABILITY OF UNIT AT TIME OF AUDIT:

  • CONDITION OF UNIT AT TIME OF AUDIT:

  • RECOMMENDATION FOR REFURBISHMENT (INCLUSION IN CAPITAL WORKS PROGRAMME)

  • LIFE EXPECTANCY OF EQUIPMENT BEFORE REFURBISHMENT/REPLACEMENT

  • HAS ANY MONEY BEEN SPENT ON EQUIPMENT IN LAST 12 MONTHS

  • GENERAL OVERALL REVIEW/FURTHER ACTIONS REQUIRED

  • BUDGET COST FOR WORKS

SIGNATURES

  • CONTRACTOR

  • PMLC LTD

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.