Information
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Project Name
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Client / Enduser
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Conducted on
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Prepared by
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Location
FAT - Barrier Components
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Barrier Information
AVB Barrier
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Barrier Serial Number
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Nasatka Barrier Product Line
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Barrier Model
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Barrier Orientation
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Paint Scheme
- Compliant
- Meets or Exceeds Requirement
- Non-Compliant
- N/A
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Enter Sheme and Paint Color
- Housing - White
- Impact Side - Solid - White with Red Reflective STOP
- Safe Side - Solid - White with Sand Anti-Skid
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- SOLID RED
- SOLID WHITE
- SOLID BLACK
- SOLID YELLOW
- No Paint - GALVANIZED ONLY
- CUSTOM COLOR
- "STOP" DECAL
- RED CHEVRONS
- RED STRIPES
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Safe Side Picture
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Impact Side Pictue
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Describe Non-Compliant and Corrective Action
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Base Plate Barrier Component
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Gate Plate Barrier Component
- Gate Plate -UP/SECURED/CLOSED - Tested - Passed
- Gate Plate - DOWN/OPEN/UNSECURED - Tested - Passed
- Not Tested
- Failed
- N/A
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Hinge Clips Barrier Component
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Integrated Gate Arm Barrier Component
- Gate Arm - UP/OPEN/UNSECURED - Tested - Passed
- Gate Arm - DOWN/CLOSED/SECURED - Tested - Passed
- Not Tested
- N/A
- Failed
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Traffic Signal Barrier Component
- Single Direction Traffic Light Assembly
- Dual Direction Traffic Light Assembly
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Signal LED Colors
- RED / YELLOW / GREEN
- RED / YELLOW / FLASHING YELLOW (HYBRID)
- RED / YELLOW
- RED / AMBER
- RED / GREEN
- RED FLASHING
- YELLOW FLASHING
- RED / YELLOW FLASHING
- RED
- YELLOW
- GREEN
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Housing Barrier Components
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Electric Motor and Gear
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Variable Frequency Drive
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Power Selection - 480/3/60 - Electric w/ Brake
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Limit/Prox switches
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Spring Assembly
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Lifting Bar
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Barrier Control Components
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Programmable Logic Controller (PLC)
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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PLC Touchscreen (mounted on door)
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Loop Detector Module
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Surge Protection Device
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Power Supply
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
1. Sequence of Operations - Normal Mode
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SECURED/CLOSED/UP position initiated via the push button on User Interface Panel?
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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UNSECURED/OPEN/DOWN Position initiated via push button on User Interface Panel?
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Barrier goes to the SECURED/CLOSED/UP position in standard operating time?
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Barrier goes to the UNSECURED/OPEN/DOWN position in standard operating time?
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Verified TRAFFIC ARM - ARM in the DOWN POSITION when Barrier is in the SECURED/CLOSED/UP Position are functional.
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Verify Traffic Signal is Red - Barrier in the SECURED/UP/CLOSED Position
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Verified all TRAFFIC ARM - ARM in the UP POSITION when Barrier is in the UNSECURED/OPEN/DOWN Position are functional.
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Verify Traffic Signal is in Yellow - Barrier in the DOWN/OPEN/UNSECURED Position
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
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Comments
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Perform a Visual Inspection of Barrier for any damages.
2. SoO - EMERGENCY FAST OPERATION (EFO) OR EMERGENCY SECURE OPERATION (ESO)
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ALL Barrier(s) are in UNSECURED/OPEN/DOWN Position. Initiate EFO/E-UP Push Button on User Interface Panel and Barrier(s) move to SECURE/CLOSE/UP position. (Safety loops and Photo Eye are bypassed by EFO/ESO command)
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
3. Sequence of Operations - SPECIAL MODE/MANUAL MODE.
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Manual Operation of Barrier.
- Tested and Functional - Passed
- Compliant
- Tested and Non-Functional- Failed
- Installed
- Non-Compliant
- Not Installed
- Damaged
- Missing
- Not Tested
- To Be Field Tested
APPROVAL AND ACCEPTANCE
9.0 APPROVAL and ACCEPTANCE AUTHORIZED SIGNATURES
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ELECTRONIC SIGNATURE ACKNOWLEDGE, I AGREE THAT MY ELECTRONIC SIGNATURE
IS A LEGALLY BINDING EQUIVALENT TO MY HANDWRITTEN SIGNATURE. WHENEVER I
EXECUTE AN ELECTRONIC SIGNATURE, IT HAS THE SAME VALIDITY AND MEANING AS
MY HANDWRITTEN SIGNATURE. I WILL NOT AT ANY TIME IN THE FUTURE, REPUDIATE
THE MEANING OF MY ELECTRONIC SIGNATURE OR CLAIM THAT MY ELECTRONIC SIGNATURE IS NOT LEGALLY BINDING. -
Nasatka Representative
