Stairlift annual inspection

• Document No.

• Audit Title

• Client / Site

• Model

• Serial Number

• Conducted on

  Date

• Prepared by

Inspection Scheudle

• Mains supply

  Good

  Faulty (see comments)

  n/a

• Charger

  Good

  Faulty (see comments)

  n/a

• Batteries

  Good

  Faulty (see comments)

  n/a

• Call & sends / remotes

  Good

  Faulty (see comments)

  n/a

• Charging points / strip

  Good

  Faulty (see comments)

  n/a

• Footrest

  Good

  Faulty (see comments)

  n/a

• Hinge track

  Good

  Faulty (see comments)

  n/a

• Sliding rail

  Good

  Faulty (see comments)

  n/a

• Limit switches

  Good

  Faulty (see comments)

  n/a

• Motor / gearbox

  Good

  Faulty (see comments)

  n/a

• Overspeed Governor

  Good

  Faulty (see comments)

  n/a

• Rollers

  Good

  Faulty (see comments)

  n/a

• Safety Edges

  Good

  Faulty (see comments)

  n/a

• Rail (rack and fixings inc)

  Good

  Faulty (see comments)

  n/a

• Seat belt

  Good

  Faulty (see comments)

  n/a

• Seat swivel

  Good

  Faulty (see comments)

  n/a

• Seat controls

  Good

  Faulty (see comments)

  n/a

• Upholstery

  Good

  Faulty (see comments)

  n/a

Summary

• Work carried out, parts used, further comments

• Additional work required

• The above work description is a correct representation of work carried out and a full report on condition of equipment

• Engineers signature

  Sign

• To my best knowledge the above work has been completed and is report is correct

• Clients signature

  Sign