Title Page

  • Site conducted

  • Community Name

  • Prepared by

Location #1

  • Location of Gates
  • Date of Inspection

  • General Comments

  • Overall Condition of Gates

  • What type of gate is used?

Slide Gates

Entrance Swing Gates

    Entrance Primary
  • Loop Sealant

  • Are there any visible welds that are splitting?

  • Gate Rollers

  • What size rollers are being used

  • Slide Gate Track Assembly

  • How thick is the gate track

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on Site?

  • Operator Frame

  • Operator Concrete Anchors

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Condition

  • Battery Age

  • Is a Battery Backup Setup Installed?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • How many motors does this operator use? (not including BB motor)

  • Limit Cams

  • Were limit cams replaced on site?

  • Photo Eye/Contact Sensor

  • Comments

  • Primary Operator
  • Loop Sealant

  • Rollers

  • Wheel Encasements

  • Guides

  • Emergency Disconnect

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on site?

  • Operator Frame

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • Limit Cams

  • Were the limit cams replaced on site?

  • Photo Eye/Contact Sensor

  • Have the loops been insulation tested this year already?<br>*Loops only require annual testing

  • Safety Loop

  • Center Loop

  • AVI Loop

  • Exit Loop

  • Comments

  • Secondary Operator
  • Rollers

  • Wheel Encasements

  • Guides

  • Emergency Disconnect

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on site?

  • Operator Frame

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • Limit Cams

  • Were the limit cams replaced on site?

  • Comments

Entrance Swing Gates

    Entrance Primary
  • Loop Sealant

  • Are there any visible welds that are splitting?

  • Gate Hinges

  • What type of hinges need to be installed?

  • Swing Arm Assembly

  • What welds need to be repaired?

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on Site?

  • Operator Frame

  • Operator Concrete Anchors

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Condition

  • Battery Age

  • Is a Battery Backup Setup Installed?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • How many motors does this operator use? (not including BB motor)

  • Limit Cams

  • Were limit cams replaced on site?

  • Photo Eye/Contact Sensor

  • Have the loops been insulation tested this year already? If not, the results will be listed below.<br>*Loops only require annual testing

  • Safety Loop

  • Center Loop

  • AVI Loop

  • Comments

  • Entrance Secondary
  • Gate Hinges

  • What type of hinges need to be installed?

  • Are there any visible welds that are splitting?

  • Swing Arm Assembly

  • What welds need to be repaired?

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on Site?

  • Operator Frame

  • Operator Concrete Anchors

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Condition

  • Battery Age

  • Is a Battery Backup Setup Installed?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • How many motors does this operator use? (not including BB motor)

  • Limit Cams

  • Were limit cams replaced on site?

  • Photo Eye/Contact Sensor

  • Comments

Exit Swing Gates

    Exit Primary
  • Loop Sealant

  • Are there any visible welds that are splitting?

  • Gate Hinges

  • What type of hinges need to be installed?

  • Swing Arm Assembly

  • What welds need to be repaired?

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on Site?

  • Operator Frame

  • Operator Concrete Anchors

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Condition

  • Battery Age

  • Is a Battery Backup Setup Installed?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • How many motors does this operator use? (not including BB motor)

  • Limit Cams

  • Were limit cams replaced on site?

  • Photo Eye/Contact Sensor

  • Have the loops been insulation tested this year already? If not, the results will be listed below.<br>*Loops only require annual testing

  • Safety Loop

  • Center Loop

  • Exit Loop

  • Comments

  • Exit Secondary
  • Gate Hinges

  • What type of hinges need to be installed?

  • Are there any visible welds that are splitting?

  • Swing Arm Assembly

  • What welds need to be repaired?

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on Site?

  • Operator Frame

  • Operator Concrete Anchors

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Condition

  • Battery Age

  • Is a Battery Backup Setup Installed?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • How many motors does this operator use? (not including BB motor)

  • Limit Cams

  • Were limit cams replaced on site?

  • Photo Eye/Contact Sensor

  • Comments

Pedestrian Gate

    Pedestrian Gate #1
  • Pedestrian Gate Location

  • Hinges

  • Door Handle

  • Gate Condition

  • Pedestrian Gate #2
  • Pedestrian Gate Location

  • Hinges

  • Door Handle

  • Gate Condition

  • Fire Code
  • Is there a Knox Box on site?

Location #2

  • Location of Gates
  • Date of Inspection

  • General Comments

  • Overall Condition of Gates

  • What type of gate is used?

Slide Gates

    Primary Operator
  • Loop Sealant

  • Rollers

  • Wheel Encasements

  • Guides

  • Emergency Disconnect

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on site?

  • Operator Frame

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • Limit Cams

  • Were the limit cams replaced on site?

  • Photo Eye/Contact Sensor

  • Have the loops been insulation tested this year already?<br>*Loops only require annual testing

  • Safety Loop

  • Center Loop

  • AVI Loop

  • Exit Loop

  • Comments

  • Secondary Operator
  • Rollers

  • Wheel Encasements

  • Guides

  • Emergency Disconnect

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on site?

  • Operator Frame

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • Limit Cams

  • Were the limit cams replaced on site?

  • Comments

Entrance Swing Gates

    Entrance Primary
  • Loop Sealant

  • Are there any visible welds that are splitting?

  • Gate Hinges

  • What type of hinges need to be installed?

  • Swing Arm Assembly

  • What welds need to be repaired?

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on Site?

  • Operator Frame

  • Operator Concrete Anchors

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Condition

  • Battery Age

  • Is a Battery Backup Setup Installed?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • How many motors does this operator use? (not including BB motor)

  • Limit Cams

  • Were limit cams replaced on site?

  • Photo Eye/Contact Sensor

  • Have the loops been insulation tested this year already? If not, the results will be listed below.<br>*Loops only require annual testing

  • Safety Loop

  • Center Loop

  • AVI Loop

  • Comments

  • Entrance Secondary
  • Gate Hinges

  • What type of hinges need to be installed?

  • Are there any visible welds that are splitting?

  • Swing Arm Assembly

  • What welds need to be repaired?

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on Site?

  • Operator Frame

  • Operator Concrete Anchors

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Condition

  • Battery Age

  • Is a Battery Backup Setup Installed?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • How many motors does this operator use? (not including BB motor)

  • Limit Cams

  • Were limit cams replaced on site?

  • Photo Eye/Contact Sensor

  • Comments

Exit Swing Gates

    Exit Primary
  • Loop Sealant

  • Are there any visible welds that are splitting?

  • Gate Hinges

  • What type of hinges need to be installed?

  • Swing Arm Assembly

  • What welds need to be repaired?

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on Site?

  • Operator Frame

  • Operator Concrete Anchors

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Condition

  • Battery Age

  • Is a Battery Backup Setup Installed?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • How many motors does this operator use? (not including BB motor)

  • Limit Cams

  • Were limit cams replaced on site?

  • Photo Eye/Contact Sensor

  • Have the loops been insulation tested this year already? If not, the results will be listed below.<br>*Loops only require annual testing

  • Safety Loop

  • Center Loop

  • Exit Loop

  • Comments

  • Exit Secondary
  • Gate Hinges

  • What type of hinges need to be installed?

  • Are there any visible welds that are splitting?

  • Swing Arm Assembly

  • What welds need to be repaired?

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on Site?

  • Operator Frame

  • Operator Concrete Anchors

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Condition

  • Battery Age

  • Is a Battery Backup Setup Installed?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • How many motors does this operator use? (not including BB motor)

  • Limit Cams

  • Were limit cams replaced on site?

  • Photo Eye/Contact Sensor

  • Comments

Pedestrian Gate

    Pedestrian Gate #1
  • Pedestrian Gate Location

  • Hinges

  • Door Handle

  • Gate Condition

  • Pedestrian Gate #2
  • Pedestrian Gate Location

  • Hinges

  • Door Handle

  • Gate Condition

Location #3

  • Location of Gates
  • Date of Inspection

  • General Comments

  • Overall Condition of Gates

  • What type of gate is used?

Slide Gates

    Entrance Primary
  • Loop Sealant

  • Rollers

  • Wheel Encasements

  • Guides

  • Emergency Disconnect

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on site?

  • Operator Frame

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • Limit Cams

  • Were the limit cams replaced on site?

  • Photo Eye/Contact Sensor

  • Have the loops been insulation tested this year already?<br>*Loops only require annual testing

  • Safety Loop

  • Center Loop

  • AVI Loop

  • Exit Loop

  • Comments

  • Entrance Secondary
  • Rollers

  • Wheel Encasements

  • Guides

  • Emergency Disconnect

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on site?

  • Operator Frame

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • Limit Cams

  • Were the limit cams replaced on site?

  • Comments

Entrance Swing Gates

    Entrance Primary
  • Loop Sealant

  • Are there any visible welds that are splitting?

  • Gate Hinges

  • What type of hinges need to be installed?

  • Swing Arm Assembly

  • What welds need to be repaired?

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on Site?

  • Operator Frame

  • Operator Concrete Anchors

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Condition

  • Battery Age

  • Is a Battery Backup Setup Installed?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • How many motors does this operator use? (not including BB motor)

  • Limit Cams

  • Were limit cams replaced on site?

  • Photo Eye/Contact Sensor

  • Have the loops been insulation tested this year already? If not, the results will be listed below.<br>*Loops only require annual testing

  • Safety Loop

  • Center Loop

  • AVI Loop

  • Comments

  • Entrance Secondary
  • Gate Hinges

  • What type of hinges need to be installed?

  • Are there any visible welds that are splitting?

  • Swing Arm Assembly

  • What welds need to be repaired?

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on Site?

  • Operator Frame

  • Operator Concrete Anchors

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Condition

  • Battery Age

  • Is a Battery Backup Setup Installed?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • How many motors does this operator use? (not including BB motor)

  • Limit Cams

  • Were limit cams replaced on site?

  • Photo Eye/Contact Sensor

  • Comments

Exit Swing Gates

    Exit Primary
  • Loop Sealant

  • Are there any visible welds that are splitting?

  • Gate Hinges

  • What type of hinges need to be installed?

  • Swing Arm Assembly

  • What welds need to be repaired?

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on Site?

  • Operator Frame

  • Operator Concrete Anchors

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Condition

  • Battery Age

  • Is a Battery Backup Setup Installed?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • How many motors does this operator use? (not including BB motor)

  • Limit Cams

  • Were limit cams replaced on site?

  • Photo Eye/Contact Sensor

  • Have the loops been insulation tested this year already? If not, the results will be listed below.<br>*Loops only require annual testing

  • Safety Loop

  • Center Loop

  • Exit Loop

  • Comments

  • Exit Secondary
  • Gate Hinges

  • What type of hinges need to be installed?

  • Are there any visible welds that are splitting?

  • Swing Arm Assembly

  • What welds need to be repaired?

  • Operator Model & Age

  • Is the operator belt driven or direct drive?

  • What is the condition of the belt?

  • What size is the belt?

  • Was the belt replaced on Site?

  • Operator Frame

  • Operator Concrete Anchors

  • Operator Mounting Pad

  • Conduit Surrounding Operator

  • Gear Box & Gear Reducer

  • Does operator run on AC or DC?

  • Battery Condition

  • Battery Age

  • Is a Battery Backup Setup Installed?

  • Battery Backup Controller

  • Battery Backup Motor

  • Battery Condition

  • Battery Age

  • How many motors does this operator use? (not including BB motor)

  • Limit Cams

  • Were limit cams replaced on site?

  • Photo Eye/Contact Sensor

  • Comments

Pedestrian Gate

    Pedestrian Gate #1
  • Pedestrian Gate Location

  • Hinges

  • Door Handle

  • Gate Condition

  • Pedestrian Gate #2
  • Pedestrian Gate Location

  • Hinges

  • Door Handle

  • Gate Condition

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.