Information
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Document No.
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Conducted on
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Job Name
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Job Address
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Location Number and Contact
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Prepared by
Escalator Information
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Escalator Name/Number
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Escalator State Number
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Type of Escalator
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Escalator Manufacture
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Approximate Number of Steps/Rise
Machine Room
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Cleanliness
- Good
- Fair
- Poor
- Acceptable Considering Overall Condition of the Equipment
- No Obvious Jumpers
- Not Applicable
- Not Able to Check
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Controller Cleanliness
- Good
- Fair
- Poor
- Acceptable Considering Overall Condition of the Equipment
- No Obvious Jumpers
- Not Applicable
- Not Able to Check
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Relay Covers Installed
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Brake Adjusted
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Chains Lubricated
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Missing Step Switch Operational
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Automatic Oiler Full and Operational
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Check Charts Current
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Controller Fuses Correct Amps
Truss
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Cleanliness
- Good
- Fair
- Poor
- Acceptable Considering Overall Condition of the Equipment
- No Obvious Jumpers
- Not Applicable
- Not Able to Check
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Step Treads/Demarcation Plates
- Good
- Fair
- Poor
- Acceptable Considering Overall Condition of the Equipment
- No Obvious Jumpers
- Not Applicable
- Not Able to Check
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Comb Plates
- Good
- Fair
- Poor
- Acceptable Considering Overall Condition of the Equipment
- No Obvious Jumpers
- Not Applicable
- Not Able to Check
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Skirt Gaps
- Good
- Fair
- Poor
- Acceptable Considering Overall Condition of the Equipment
- No Obvious Jumpers
- Not Applicable
- Not Able to Check
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Skirt and Deck Screws
- Good
- Fair
- Poor
- Acceptable Considering Overall Condition of the Equipment
- No Obvious Jumpers
- Not Applicable
- Not Able to Check
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Handrail Condition
- Good
- Fair
- Poor
- Acceptable Considering Overall Condition of the Equipment
- No Obvious Jumpers
- Not Applicable
- Not Able to Check
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Stop Switch Covers
- Good
- Fair
- Poor
- Acceptable Considering Overall Condition of the Equipment
- No Obvious Jumpers
- Not Applicable
- Not Able to Check
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Handrail Drive Chains
- Good
- Fair
- Poor
- Acceptable Considering Overall Condition of the Equipment
- No Obvious Jumpers
- Not Applicable
- Not Able to Check
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Key Switches Operational
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Ride Quality
- Good
- Fair
- Poor
- Acceptable Considering Overall Condition of the Equipment
- No Obvious Jumpers
- Not Applicable
- Not Able to Check
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General Noise
- Good
- Fair
- Poor
- Acceptable Considering Overall Condition of the Equipment
- No Obvious Jumpers
- Not Applicable
- Not Able to Check
Pit
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Cleanliness
- Good
- Fair
- Poor
- Acceptable Considering Overall Condition of the Equipment
- No Obvious Jumpers
- Not Applicable
- Not Able to Check
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Stop Switch Operational
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Tension Carriage Adjusted
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Notes: