Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Untitled Page

  • LIFT MOTOR ROOM NO 1

Room Condition

  • Room Condition

  • Room Lightings

  • Exit Lights

  • Door Closer Faulty

  • Lockset Working Condition

GL1

  • Abnormal noise from traction machine (Vibration, Machinery Noise)

  • Hoisting Ropes Condition (Rusty, Broken Strands, Locknuts & Bolts Condition, Etc)

  • Governor Ropes Machines (Rusty rope, Abnormal Noise, Etc)

  • Brake Drums (Free from dirt, scratches, oil/grease)

  • UPS/ARD Condition

  • Any Floor Opening

  • Electrical Equipment (Not exposed to dust / excessive moisture)

  • Wiring Condition (No short circuit, electrical arcing or possibility of electrical shocks)

Electrical Equipment

  • Electrical Equipment (Not exposed to dust / excessive moisture)

  • Wiring Condition (No short circuit, electrical arcing or possibility of electrical shocks)

  • Any Circuit Trip<br>

  • Indicator Lights

GL2

  • Abnormal noise from traction machine (Vibration, Machinery Noise)

  • Hoisting Ropes Condition (Rusty, Broken Strands, Etc)

  • Governor Ropes Machines (Rusty rope, Abnormal Noise, Etc)

  • Voltage Measurement (0-20V)

  • Current Measurement (A)

  • UPS/ARD Condition

  • Any Floor Opening

Electrical Equipment

  • Electrical Equipment (Not exposed to dust / excessive moisture)

  • Wiring Condition (No short circuit, electrical arcing or possibility of electrical shocks)

  • Any Circuit Trip<br>

  • Indicator Lights

GL3

  • Abnormal noise from traction machine (Vibration, Machinery Noise)

  • Hoisting Ropes Condition (Rusty, Broken Strands, Etc)

  • Governor Ropes Machines (Rusty rope, Abnormal Noise, Etc)

  • UPS/ARD Condition

  • Any Floor Opening

Electrical Equipment

  • Electrical Equipment (Not exposed to dust / excessive moisture)

  • Wiring Condition (No short circuit, electrical arcing or possibility of electrical shocks)

  • Any Circuit Trip<br>

  • Indicator Lights

DDC Panel

  • DDC All Controller Status

  • DDC UPS Condition

Exhaust Fan

  • EAF-RF-05

  • Selector Position<br>

  • Push Button Condition<br>

  • Indicator Light

  • Any Circuit Trip

  • Interlock during "Manual Mode"

  • FAF-RF-05

  • Selector Position<br>

  • Push Button Condition<br>

  • Indicator Light

  • Any Circuit Trip

  • Interlock during "Manual Mode"

  • Current Measurement (A)

  • L1

  • L2

  • L3

  • LIFT MOTOR ROOM NO 2

Room Condition

  • Room Condition

  • Room Lightings

  • Exit Lights

  • Door Closer Faulty

  • Lockset Working Condition

GL4

  • Abnormal noise from traction machine (Vibration, Machinery Noise)

  • Hoisting Ropes Condition (Rusty, Broken Strands, Etc)

  • Governor Ropes Machines (Rusty rope, Abnormal Noise, Etc)

  • UPS/ARD Condition

  • Any Floor Opening

Electrical Equipment

  • Electrical Equipment (Not exposed to dust / excessive moisture)

  • Wiring Condition (No short circuit, electrical arcing or possibility of electrical shocks)

  • Any Circuit Trip<br>

  • Indicator Lights

GL5

  • Abnormal noise from traction machine (Vibration, Machinery Noise)

  • Hoisting Ropes Condition (Rusty, Broken Strands, Etc)

  • Governor Ropes Machines (Rusty rope, Abnormal Noise, Etc)

  • UPS/ARD Condition

  • Any Floor Opening

Electrical Equipment

  • Electrical Equipment (Not exposed to dust / excessive moisture)

  • Wiring Condition (No short circuit, electrical arcing or possibility of electrical shocks)

  • Any Circuit Trip<br>

  • Indicator Lights

GL6

  • Abnormal noise from traction machine (Vibration, Machinery Noise)

  • Hoisting Ropes Condition (Rusty, Broken Strands, Etc)

  • Governor Ropes Machines (Rusty rope, Abnormal Noise, Etc)

  • UPS/ARD Condition

  • Any Floor Opening

Electrical Equipment

  • Electrical Equipment (Not exposed to dust / excessive moisture)

  • Wiring Condition (No short circuit, electrical arcing or possibility of electrical shocks)

  • Any Circuit Trip<br>

  • Indicator Lights

DDC Panel

  • DDC All Controller Status

  • DDC UPS Condition

Exhaust Fan

  • EAF-RF-06

  • Selector Position<br>

  • Push Button Condition<br>

  • Indicator Light

  • Any Circuit Trip

  • Interlock during "Manual Mode"

  • FAF-RF-06

  • Selector Position<br>

  • Push Button Condition<br>

  • Indicator Light

  • Any Circuit Trip

  • Interlock during "Manual Mode"

  • Current Measurement (A)

  • L1

  • L2

  • L3

Note: Any findings shall be recorded in the Remarks Column

  • Remarks:

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.