Information

  • JOB AUDIT TITLE INCLUDING JOB NUMBER

  • CLIENT /SITE

  • ENGINEER

  • Conducted on

  • Location
  • Prepared by

LIFT DETAILS

  • Lift Make / Lift Model and Serial Number

GENERAL

  • Check all Oil and Grease Levels

  • Clean Lift / Pit Equipment / Motor Room / Car Top

LANDINGS

  • Landing Pushes and Indicators

LIFT CAR

  • Car Pushes and Indicators

  • Autodial / Alarm

  • Floor Levelling / Relevelling Operation

  • Check Lift Car Lighting

  • Lift Car Visual Check / Mirror / Load Plate / Hand Rail

  • Car Door Operation

  • Door Protection / Safety Edges / Light Ray Units

CAR TOP

  • Door Contacts

  • Door Rollers / Kicking Rollers

  • Track Slides and Cills - Clean

  • Air Cords

  • Ramp / Skate

  • Door Locks

  • Guide Shoes / Car / Counterweights Visual Only

  • Tape Head / Signal Switches / Shoes

  • Car Top Control / Stop Switch Operation

  • Car Top Light

SHAFT

  • Safety Gear Visual Check

  • Ropes / Chains / Terminations Visual Check

  • Shaft Lighting

MOTOR ROOM

  • MRL ONLY - Check Brake Release and Battery

  • Controller Visual Check

  • Controller - Are Correct Fuses fitted?

  • Check Lift Emergency Lighting

  • Brake Visual Check

  • Gear / Hydraulic Unit / Hydraulic Fluid

  • Sheaves / Divertors Visual Check + Lubrication

  • Hand Pump

MOTOR ROOM SAFETY

  • Lighting

  • Emergency Lighting

  • Hand Wiring Buzzer / Indication

LOG CARD

  • Sign and Date Log Card

NOTES and RECOMMENDATIONS

  • NOTES

  • RECCOMMENDATIONS

  • PLEASE TAKE ANY ADDITIONAL PHOTOS IF REQUIRED

ENGINEERS SIGNATURE

  • Engineer - Please Print Name and Sign

CUSTOMERS SIGNATURE

  • This equipment has been serviced in accordance with the contract and has been left in a satisfactory, safe and serviceable condition.

  • Customers - Please Print Name and Sign

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.