Information
PLEASE COMPLETE THIS SECTION IN BLOCK CAPITALS - DOUBLE TAP ON SHIFT KEY MAKES BLOCK CAPS
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JOB TITLE. e.g. SITE NAME - LIFT 1 - JOB 9999
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SITE NAME
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ENGINEER
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Conducted on
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Location
PLEASE ENTER DETAILS OF THE LIFT
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E.G. Lift Make / Lift Model / Serial Number
NEW USEFUL INFORMATION - E.G. DOOR CODES / ACCESS OR CONTACT DETAILS / LIFT INFO etc.
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PLEASE ENTER ANY NEW USEFUL INFO WHICH WILL BE HELPFUL TO KNOW FOR FUTURE VISITS
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TAKE PHOTOS IF RELEVANT TO DO WITH ANY NEW USEFUL INFO TO DO WITH SITE OR LIFT
ACCESS TO THE MOTOR ROOM
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Is there safe access to the Motor Room?
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Risk Level
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Access lighting to the Motor Room is adequate?
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Risk Level
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Is there clear unobstructed entry to the Motor Room?
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Risk Level
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Correct type of lock fitted to the Motor Room Door?
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Risk Level
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Motor Room Door locked?
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Risk Level
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Motor Room Door fitted with Danger Sign?
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Risk Level
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Motor Room light switch adjacent to entry point?
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Risk Level
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Is an oil barrier fitted in front or behind door?
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Risk Level
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Does Motor Room Door have a Tripping Hazard Sign?
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Risk Level
INSIDE THE MOTOR ROOM
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Does Motor Room have Emergency Lighting?
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Risk Level
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Has the Mains Isolator been fitted adjacent to the entry point?
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Risk Level
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Is the Isolator marked Lift Main Switch?
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Risk Level
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Is a lift parking sign been fitted to the Isolator?<br>
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Risk Level
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Can the Isolator be locked in the OFF position?
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Risk Level
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Is there an Electric Shock Card positioned in the main Isolator Box?
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Risk Level
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Is there a Landing Release Key available in the Motor Room?
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Risk Level
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If more than one Lift, are both Isolators identified?
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Risk Level
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Is there only Lift Equipment in the Motor Room?
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Risk Level
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Is the Lift Equipment guarded / separate?
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Risk Level
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Does the Lift Room have the correct type of ventilation?
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Risk Level
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Is the heating level correct?
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Risk Level
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Does Motor Room have trap doors and are they strong / guarded / sign fitted?
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Risk Level
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Is the lifting beam marked with the SWL?
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Risk Level
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Is there any raised section in the Motor Room & are they guarded?
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Risk Level
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Is a ladder fitted if they are 500mm or higher?
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Risk Level
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Is the motor room free of tripping / head hazards?
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Risk Level
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Does it have a non slip floor?
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Risk Level
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Is there a fire extinguisher (Black Type)?
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Risk Level
MAIN LIFT CONTROLLER
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Is there a Danger Sign 415 volts?
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Risk Level
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Is there a full width rubber Safety Mat in front of the Controller?
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Risk Level
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Is there a rubber mat fitted behind the controller if required?
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Risk Level
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If more than one lift are the controllers identified?
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Risk Level
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Fitted with warning signs if power still on when one is turned off?
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Risk Level
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Is there a clear distance of 900mm in front of the main Controller?
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Risk Level
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Is there a warning sign fitted to the controller isolator before opening?
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Risk Level
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Are there Controller wiring diagrams of correct type for this controller?
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Risk Level
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Have all objects been removed from the top of the Controller?
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Risk Level
HYDRAULIC TANK / GEAR AREA
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Is there a safe working clearance above the gear / tank area (300mm)?
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Risk Level
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Is there a hand winding wheel and is it of the spoke less type?
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Risk Level
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Painted Yellow?
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Risk Level
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Is a Brake Handle present?
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Risk Level
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Pump Handle and does it work correctly?
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Risk Level
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Hand Winding Instruction Sign & visible?
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Risk Level
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Is there a safe working area for Hand Winding?
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Risk Level
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Are guards fitted to the machine / governor unit?
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Risk Level
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Do the guards allow safe servicing?
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Risk Level
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Is there a Stop Switch fitted by the gear / motor / tank units?
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Risk Level
TOP OF LIFT CAR
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Is the Roof strong enough for man and tools?
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Risk Level
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Do the landing doors have the modern triangle release?
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Risk Level
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Has a stop switch been fitted max 1000mm from entrance of lift roof?
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Risk Level
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Has a car top control been fitted with guarded controls and a run button?
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Risk Level
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Have you tested the car top controls system turns off landing call?
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Risk Level
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Does the Lift Car have safety gear fitted - If not Do Not Ride
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Risk Level
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Are there any tripping hazards on roof?
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Risk Level
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Is there a Gap of 300mm or more around roof top therefore constituting a fall hazard?
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Risk Level
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Are there any finger trap areas / driving wheel / divertor wheels?
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Risk Level
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Is there a fixed light plus is it guarded?
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Risk Level
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Has a test up limit been fitted?
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Risk Level
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Does it stop the lift 1800mm from the first strike point?
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Risk Level
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Does the car top have low head room signs in place?
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Risk Level
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Is there a car top hand rail plus sign in place?
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Risk Level
LIFT SHAFT
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Is there a landing safety barrier available?
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Risk Level
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Is the lift shaft adequately illuminated?
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Risk Level
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Are all lock box covers fitted?
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Risk Level
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Are all landing doors fitted with closers?
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Risk Level
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Do all landing and car locks - electrically and mechanically work correctly?
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Risk Level
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Does the overhead lifting beam have a SWL Sign fitted?
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Risk Level
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Are all landing doors solid type (not lattice type) finger traps?
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Risk Level
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Are all landing and car toe guards fitted?
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Risk Level
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If two lifts in same shaft is screening guard been fitted?
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Risk Level
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Has top and bottom floor identification been visually marked?
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Risk Level
LIFT PIT AREA
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Has a lift pit stop switch been fitted that can be reached from the landing?
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Risk Level
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And lift pit safely?
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Risk Level
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Is it marked STOP?
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Risk Level
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Has a pit ladder been fitted plus hand grips?
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Risk Level
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Is there an interlocked pit prop available?
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Risk Level
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Has the pit prop been clearly labeled?
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Risk Level
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Is there a pit prop warning sign?
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Risk Level
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Is a pit warning sign required?
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Risk Level
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Has the hydraulic ram been fitted with a rupture valve?
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Risk Level
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Does this lift operate in an enviroment that requires special safety equipment or has hazards that may require two man working for safety?
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Risk Level
Asbestos
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Is there an Asbestos register present?
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Has Asbestos been identified at the site?
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Risk Level
RISK ASSESSMENT COMPLETE
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Select date
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Engineer Signature