NASATKA - BARRIER MAINTENANCE - CHECK LIST - FORM 505

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

FILL OUT FORM COMPLETELY, DO NOT LEAVE ANY QUESTIONS "BLANK" OR "UN-ANSWERED" (TAKE PICTURES IF POSSIBLE)

BARRIER INFORMATION

• ENTER BARRIER MODEL:

  Yes

  No

  N/A

• ENTER HPU CONTROL PANEL TYPE:

  Yes

  No

  N/A

• ENTER BARRIER SERIAL NUMBER.

  Yes

  No

  N/A

BARRIER

• INSPECTED BARRIER APPEARANCE?<br>(COMMENT ON CONDITION OF BARRIER, TAKE PICTURE IF POSSIBLE)

  Yes

  No

  N/A

• CLEANED AROUND BARRIER PLATE?

  Yes

  No

  N/A

• CLEANED AROUND BARRIER DRAINS?

  Yes

  No

  N/A

• CHECKED BOTH KNEE BRACE COVERS AND BOLTS?

  Yes

  No

  N/A

• CHECKED "STOP" DECAL ON BARRIER FRONT?

  Yes

  No

  N/A

• CHECKED CONDITION OF "ANTI-SKID" ON BARRIER PLATE?

  Yes

  No

  N/A

• CHECKED CONDITION OF "PAINT COLOR" ON BARRIER PLATE?

  Yes

  No

  N/A

• CHECKED GREASE FITTINGS ON BARRIERS?

  Yes

  No

  N/A

• CHECKED BARRIER PLATE "LEVEL" WHEN IN THE DOWN/OPEN POSITION?

  Yes

  No

  N/A

• ARE BARRIER DRAIN COVERS INSTALL?<br>(IF MISSING ENTER SIZE IN COMMENTS)

  Yes

  No

  N/A

• CHECKED DOWN LIMIT SWITCH AND MOUNT?

  Yes

  No

  N/A

• CHECKED DOWN LIMIT SWITCH WIRES AND CONNECTIONS?

  Yes

  No

  N/A

• CHECKED CONTROL PANEL WIRING TO BE NEAT AND SEATED?

  Yes

  No

  N/A

• CHECKED BARRIER TO SEE IF IT MAKING ANY NOISE?<br>

  Yes

  No

  N/A

HPU

• CHECKED BARRIER HPU CONDITION?<br>(ENTER COMMENTS/TAKE PICTURE)

  Yes

  No

  N/A

• CHECKED HYDRAULIC CYLINDER?

  Yes

  No

  N/A

• CHECKED HYDRAULIC HOSES AND CONNECTIONS TO CYLINDER?

  Yes

  No

  N/A

• CHECKED HYDRAULIC HOSES AND CONNECTIONS TO ACCUMULATOR?

  Yes

  No

  N/A

• CHECK ACCUMULATOR PRESSURE? (RECORD PRESSURE READING)

  Yes

  No

  N/A

• CHECKED HYDRAULIC HOSES AND CONNECTIONS TO MAIN HOSE LINE?

  Yes

  No

  N/A

• CHECKED HPU POWER?<br>(RECORD POWER)

  Yes

  No

  N/A

• CHECKED HYDRAULIC OIL LEVEL?

  Yes

  No

  N/A

• DOES OIL LOOK CONTAMINATED?

  Yes

  No

  N/A

• DOES OIL NEED TO BE REPLACED?<br>

  Yes

  No

  N/A

• WAS THE OIL REPLACED? (IF SO, COMMENT/REPORT)

  Yes

  No

  N/A

• CHECKED HYDRAULIC OIL FOR LEAKS? (CLEAN ALL VALVES AND TANK OF DIRT AND DEBRI)

  Yes

  No

  N/A

SAFETY LOOPS

• CHECKED FRONT SAFETY LOOP?

  Yes

  No

  N/A

• CHECKED FRONT REAR SAFETYLOOP?

  Yes

  No

  N/A

• VERIFY LOOP DETECTOR SAFETY OR CARD SYSTEM<br>(RESISTANCE 2 Ohm)

  Yes

  No

  N/A

• VERIFY LOOP DETECTOR SAFETY OR CARD SYSTEM<br>(LOOP INDUCTANCE BETWEEN 70-1000 uH)

  Yes

  No

  N/A

BATTERY AND POWER

• CHECKED BATTERY CHARGER?

  Yes

  No

  N/A

• CHECKED BATTERY VOLTAGE?<br>(RECORD VOLTAGE READING)

  Yes

  No

  N/A

• CHECKED BATTERY CONVERTER?

  12 VOLT

  24 VOLT

• CHECKED BATTERY BACK-UP SYSTEM?

  Yes

  No

  N/A

• CHECKED BATTERIES FOR WIRING/HARNESS CONNECTIONS?<br>(SEATED AND CONNECTED CORRECTLY)

  Yes

  No

  N/A

BARRIER CYCLES

• CHECKED E-UP CYCLE (.75 TO 2 SECONDS) RECORD ACTUAL READING

  Yes

  No

  N/A

• BARRIER UP CYCLE (3 TO 8 SECONDS) RECORD ACTUAL READING

  Yes

  No

  N/A

• BARRIER DOWN CYCLE (3 TO 8 SECONDS) RECORD ACTUAL READING

  Yes

  No

  N/A

• DOES BARRIER RESET?

  Yes

  No

  N/A

• DOES DOWN SPEED NEED TO BE ADJUSTED? (RECORD ANY CHANGES THAT ARE MADE)

  Yes

  No

  N/A

• CHECKED PRESSURE SWITCH?

  Yes

  No

  N/A

MASTER CONTROL PANEL

• CHECKED/TESTED POWER KEY?

  Yes

  No

  N/A

• CHECKED/TESTED POWER INDICATING LIGHT?

  Yes

  No

  N/A

• CHECKED/TESTED E-UP BUTTON?

  Yes

  No

  N/A

• CHECKED/TESTED E-UP LIGHT?

  Yes

  No

  N/A

• CHECKED/TESTED E-UP ALARM?

  Yes

  No

  N/A

• CHECKED/TESTED RESET KEY?

  Yes

  No

  N/A

• CHECKED/TESTED UP BUTTON?

  Yes

  No

  N/A

• CHECKED/TESTED UP BUTTON RED INDICATING LIGHT?

  Yes

  No

  N/A

• CHECKED/TESTED DOWN BUTTON?

  Yes

  No

  N/A

• CHECKED/TESTED DOWN BUTTON GREEN INDICATING LIGHT?

  Yes

  No

  N/A

• CHECKED/TESTED POWER FAILURE INDICATING LIGHT?

  Yes

  No

  N/A

REMOTE PANEL

• CHECKED/TESTED POWER KEY?

  Yes

  No

  N/A

• CHECKED/TESTED POWER INDICATING LIGHT?

  Yes

  No

  N/A

• CHECKED/TESTED E-UP BUTTON?

  Yes

  No

  N/A

• CHECKED/TESTED E-UP LIGHT?

  Yes

  No

  N/A

• CHECKED/TESTED E-UP ALARM?

  Yes

  No

  N/A

• CHECKED/TESTED RESET KEY?

  Yes

  No

  N/A

• CHECKED/TESTED UP BUTTON?

  Yes

  No

  N/A

• CHECKED/TESTED UP BUTTON RED INDICATING LIGHT?

  Yes

  No

  N/A

• CHECKED/TESTED DOWN BUTTON?

  Yes

  No

  N/A

• CHECKED/TESTED DOWN BUTTON GREEN INDICATING LIGHT?

  Yes

  No

  N/A

• CHECKED/TESTED POWER FAILURE INDICATING LIGHT?

  Yes

  No

  N/A

GATE ARMS

• LOCATION OF GATE ARM?

  ON BARRIER

  STAND ALONE

• IS GATE ARM COMPOSITOR INSTALL IN CONTROL?

  Yes

  No

  N/A

• DOES GATE ARM RAISE WHEN BARRIER IS DOWN?

  Yes

  No

  N/A

• DOES GATE ARM LOWER WHEN BARRIER IS UP?

  Yes

  No

  N/A

TRAFFIC LIGHTS

• DOES "RED" TRAFFIC LIGHT GO ON WHEN BARRIER IS UP?

  Yes

  No

  N/A

• DOES "YELLOW" TRAFFIC LIGHT GO ON WHEN BARRIER IS DOWN?

  Yes

  No

  N/A

ADDITIONAL NOTES OR COMMENTS (IF NEEDED)

• ENTER ANY NOTES OR COMMENTS

ELECTRONIC SIGNATURE ACKNOWLEDGE

• ELECTRONIC SIGNATURE ACKNOWLEDGE, I AGREE THAT MY ELECTRONIC SIGNATURE <br>IS A LEGALLY BINDING EQUIVALENT TO MY HANDWRITTEN SIGNATURE. WHENEVER I <br>EXECUTE AN ELECTRONIC SIGNATURE, IT HAS THE SAME VALIDITY AND MEANING AS <br>MY HANDWRITTEN SIGNATURE. I WILL NOT AT ANY TIME IN THE FUTURE, REPUDIATE <br>THE MEANING OF MY ELECTRONIC SIGNATURE OR CLAIM THAT MY ELECTRONIC SIGNATURE <br>IS NOT LEGALLY BINDING.

  Yes

  No

  N/A

• NASATKA REPRESENTATIVE SIGNATURE

  Sign

• CUSTOMER REPRESENTATIVE OR AUTHORIZED REPRESENTATIVE

  Sign