Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Initial Inspection

  • Purchase Order Number

  • Initial Inspection of Door prior to full assessment being undertaken.

  • Detail why you came to this assessment.

  • Photo of the door to be added.

  • Door Type

  • Model

  • Bracket L/Hand Side

  • Bracket R/Hand Side

  • Fixings

  • Fixings Checked

  • Axle

  • Spring Tension

  • Right Hand Bearing

  • Right Hand Bush

  • Left Hand Bearing

  • Left Hand Bush

  • Slat Condition

  • Slat Alignment

  • End Clips

  • Connecting Slats

  • Wrap on Drum

  • Bottom Rail

  • Guide Fixings

  • Guide Channel Clearance

  • Guide Lead-in

  • Add any photos to support your assessment.

Chain Operated

  • Hand Chain

  • Chain Wheel

  • Planetary Gears

  • Direct Drive

  • Chain Guide

  • Chain Cleat

  • Add any photos to support your assessment.


  • Motor Bracket

  • Bolts/Nuts

  • Drive Chain

  • Sprocket Alignment

  • Sprocket Grub Screw/Keyway

  • Emergency Chain Wheel

  • Emergency Chain Operates

  • Emergency Chain Guide

  • PE Cell

  • PE Reflector

  • Floor Loop

  • Swipe Card/Key Pad/Remote

  • Limits

  • Control Box

  • Isolator

  • Add any photos to support your assessment.

Final Overall Assessment of Door.

  • What is the overall door condition?


  • Select date

  • Comments

  • Client Sigiture

  • Technician Signiture

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.