Safety Assessment Survey Report

• Safety Assessment survey Report

• Client / Site Address

• Conducted on

  Date

• Engineer:

• Date:

  Date

• Unit No:

• Lift ID:

1. Machine Room

• 1.1 Is safe access provided?

  Yes

  No

  N/A

• 1.2 Are machine/pulley rooms adequately secure from unauthorised access?

  Yes

  No

  N/A

• 1.3 Is machine room lockable?

  Yes

  No

  N/A

• 1.4 Can the motor room door be opened from the inside without a key?

  Yes

  No

  N/A

• 1.5 Is a current danger notice fitted to machine/pulley room doors?

  Yes

  No

  N/A

• 1.6 Are trap door notices fitted adjacent to trap?

  Yes

  No

  N/A

• 1.7 Are the trap door notices fitted adjacent to the access door?

  Yes

  No

  N/A

• 1.8 Is there adequate lighting to the access routes & workplace?

  Yes

  No

  N/A

• 1.9 Is the light switch adjacent to access door?

  Yes

  No

  N/A

• 1.10 Is emergency lighting provided?

  Yes

  No

  N/A

• 1.11 Can main isolator switch be locked off?

  Yes

  No

  N/A

• 1.12 Is machine room clear of head/trip hazard?

  Yes

  No

  N/A

• 1.14 Is machine room on one level?

  Yes

  No

  N/A

• 1.15 Is there a guard rail plinth over 0.5m?

  Yes

  No

  N/A

• 1.16 Are all moving parts suitably guarded?

  Yes

  No

  N/A

• 1.17 Is any handwinding shell painted yellow?

  Yes

  No

  N/A

• 1.18 Is drive sheave painted yellow?

  Yes

  No

  N/A

• 1.19 Is a handwinding wheel provided?

  Yes

  No

  N/A

• 1.20 Is a brake release provided?

  Yes

  No

  N/A

• 1.21 Is there a push to stop switch adjacent to the machine?

  Yes

  No

  N/A

• 1.22 Are handwinding instructions displayed over the machine?

  Yes

  No

  N/A

• 1.23 Are all switches adequately labelled/identified?

  Yes

  No

  N/A

• 1.24 Are lifting beams marked with SWL or DO NOT USE?

  Yes

  No

  N/A

• 1.25 Are reinforcing rod type lifting eyes fitted or provided?

  Yes

  No

  N/A

• 1.26 Is a compliant Electric Shock Notice fitted near main switch?

  Yes

  No

  N/A

• 1.27 Is trapdoor of adequate strength?

  Yes

  No

  N/A

• 1.28 Is the trapdoor counterbalanced?

  Yes

  No

  N/A

• 1.29 Is there means of safe access for replacing heavy equipment?

  Yes

  No

  N/A

• 1.30 Is a CO2 fire extinguisher provided? (state last inspection date)

  Yes

  No

  N/A

• Last inspection date: MM/YY

• 1.31 Is a minimum pressure valve fitted? (HYDRAULIC ONLY)

  Yes

  No

  N/A

• 1.32 Is an oil pressure gauge fitted? (HYDRAULIC ONLY)

  Yes

  No

  N/A

• 1.33 Is the brake asbestos free?

  Yes

  No

  N/A

• 1.34 Is there sufficient lighting in the pulley room?

  Yes

  No

  N/A

2. Controller & Selector

• 2.1 Is regret a connecting wiring notice fitted?

  Yes

  No

  N/A

• 2.2 Are controller doors and covers fitted?

  Yes

  No

  N/A

• 2.3 Are rubber mats fitted to front & rear controller and big enough?

  Yes

  No

  N/A

• 2.4 Is the top controller free from flammable materials (i.e paper etc)?

  Yes

  No

  N/A

• 2.5 Is there adequate working space?

  Yes

  No

  N/A

• 2.6 Is a full set of wiring diagrams avaialble?<br>

  Yes

  No

  N/A

• 2.7 Are all floor/slab holes properly protected/guarded?

  Yes

  No

  N/A

3. Top of Car

• 3.1 Are distances between car top and shaft walls minimal?

  Yes

  No

  N/A

• 3.2 Is top of car control fitted and complaint to BS7255?

  Yes

  No

  N/A

• 3.3 Is up test limit switch fitted 1.8m for nearest obstruction?

  Yes

  No

  N/A

• 3.4 Is a fest riches headroom notice fitted where necessary?

  Yes

  No

  N/A

• 3.5 Is the car fitted with safety gear?

  Yes

  No

  N/A

• 3.6 Is the car fitted with a rupture valve?

  Yes

  No

  N/A

• 3.7 Will the car roof support 2 men/200kgs?

  Yes

  No

  N/A

• 3.8 Does the car roof require a handrail?

  Yes

  No

  N/A

4. Shaft & Pit

• 4.1 Is shaft lighting fitted and at correct spacing?

  Yes

  No

  N/A

• 4.2 Are the landing door closers fitted?

  Yes

  No

  N/A

• 4.3 Are there landing door emergency release/escutcheon plates?

  Yes

  No

  N/A

• 4.4 Are landing door slave contacts fitted?

  Yes

  No

  N/A

• 4.5 Are glass doors fitted and free from finger traps?

  Yes

  No

  N/A

• 4.6 Are all car & landing lock covers fitted?

  Yes

  No

  N/A

• 4.7 Are fascia/toe guards fitted where appropriate?

  Yes

  No

  N/A

• 4.8 Is a counterweight screen fitted?

  Yes

  No

  N/A

• 4.9 Is a pit division screen of 2.5m high fitted?

  Yes

  No

  N/A

• 4.10 Are full length shaft division screens fitted?

  Yes

  No

  N/A

• 4.11 Are pit ladders/steps with hand holds fitted where necessary?

  Yes

  No

  N/A

• 4.12 Is a pit stop switch fitted & sited correctly?

  Yes

  No

  N/A

• 4.13 Is a landing door barrier provided?

  Yes

  No

  N/A

• 4.14 Are emergency release keys kept in a safe place?

  Yes

  No

  N/A

• 4.15 Is a pit prop available where necessary?

  Yes

  No

  N/A

• 4.16 Is a pit prop notice fitted in a prominent position where necessary?

  Yes

  No

  N/A

• 4.17 Is there a reduced pit depth notice fitted where necessary?

  Yes

  No

  N/A

• 4.18 Is the pit dry & clean?

  Yes

  No

  N/A

• 4.19 Is a socket outlet fitted in the pit?

  Yes

  No

  N/A

• 4.20 Is the shaft properly closed & protected?

  Yes

  No

  N/A

• 4.21 Is there a maximum of 6mm clearance around all doors?

  Yes

  No

  N/A

• 4.22 Is the shaft suitably ventilated?

  Yes

  No

  N/A

5. Lift Car

• 5.1 Is there a door reversal device fitted & working? (state type)

  Yes

  No

  N/A

• 5.2 Is alarm bell fitted & working?

  Yes

  No

  N/A

• 5.3 Is a telephone handset fitted & working?

  Yes

  No

  N/A

• 5.4 Is car emergency lighting fitted & working?

  Yes

  No

  N/A

• 5.5 Is a toe guard fitted to car platform?

  Yes

  No

  N/A

• 5.6 Is floor levelling to design criteria?

  Yes

  No

  N/A

• 5.7 Is car interior lighting adequate?

  Yes

  No

  N/A

• 5.8 Has the car got lift doors?

  Yes

  No

  N/A

• 5.9 Are glass doors fitted & free of finger traps?

  Yes

  No

  N/A

• 5.10 Are operating controls suitable for disabled use?

  Yes

  No

  N/A

• 5.11 Has the lift got indicators?

  Yes

  No

  N/A

• 5.12 Is the lift fitted with ascending car overspeed protection? (state type)

  Yes

  No

  N/A

• 5.13 Is a load plate fitted in lift car?

  Yes

  No

  N/A

6. General

• 6.1 Do all safety and stop switches operate correctly?

  Yes

  No

  N/A

• 6.2 Is the motor room & shaft free from suspect material?

  Yes

  No

  N/A

• 6.3 Is a bund wall fitted to pump room? (HYDRAULIC ONLY)

  Yes

  No

  N/A

6.4 SAFed LG1 Examinations/Periods

• Earth Continuity/10 yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Electrical Safety Devices/Annually

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Terminal Speed Reduction Switches/10 Yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Landing & Car Door Interlocks/10 yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Worm & Other Gearing/10 yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Shafts-Bearings-Pulleys/10 yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Roller, Ball & Needle Bearings/10 yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Overspeed Governor - Actuation/5 yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Overspeed Governor - Calibration/5 yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Safety Gear at Reduced Speed/5 yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Safety Gear at Rated Speed or 1.6mps/10 yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Overspeed of Ascending Car/10 yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Energy Dissipation Buffers at Rated Speed or 1.6mps/10 yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Energy Dissipation Buffers at Slow Speed/Annually

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Car Overload Detection Devices/Annually

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Hydraulic Systems/5 yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Hydraulic Rupture-Restrictor Valves/5 yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Hydraulic Cylinders/Annually

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Electrical Anti-Creep Systems/Annually

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Electrical Anti-Creep Device/10 yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Low Pressure Detection Devices/Annually

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Brake Condition/Annually

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Brake Dynamic/10 yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired

• Levelling/10 yearly

• Last Examination Date

  N/A

  Unknown

  Satisfactory

  Expired