Title Page

  • Document No.

  • Conducted on

  • Job Name

  • Job Address
  • Location Number and Contact

  • Prepared by

Elevator Information

  • Elevator Name/Number

  • State Number

  • Type of Elevator

  • Elevator Manufacturer

  • Stops/Openings

  • Last 5 Year Load Test

Machine Room

  • Cleanliness

  • Starter Contacts

  • Controller Cleanliness

  • Controller Jumpers

  • Relay Covers Installed

  • Valve and Misc. Covers

  • Oil Leaks, pump, valve, line

  • Floor Painted

  • Spare Parts

  • Check Charts Current

  • Controller Fuses (correct amps)

Hoistway

  • Fire Test Charts Current

  • Cleanliness

  • Rails Lubricated

  • Door Tracks Clean and Lubricated

  • Covers Installed

  • Sills Clean (check behind doors)

  • Hall Door Noise

Cab

  • P/U Rollers Adjusted and Lubricated

  • Cleanliness

  • Cartop Clean Painted

  • Door Linkage Lubricated

  • Safe Edge and Photo Eye Operational

  • Car Door Chains/Belts Adjusted

  • Car Door Operation

  • Car Door Clutch Clean and Lubricated

  • Car Door Rollers

  • Car Door Tracks

  • Cartop Lights Operational

  • COP LEDs and PI

  • Emergency Phone Operational

  • Stop Switch Operational

  • Car Guides

  • Ride Quality

Pit

  • Cleanliness

  • Packing

  • Buffers

  • Pipe Stands

  • Lights

  • Pit Can

  • Notes

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.