USMS Gate Arm PM

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Info

• Add location
  Address

• Equipment Serial Number/Location:

  Yes

  No

  N/A

Preventative Maintenance Checklist

• Describe general barrier appearance.

  Yes

  No

  N/A

• Clean Hinge Areas.

  Yes

  No

  N/A

• Stop Decal on the front of barrier.

  Yes

  No

  N/A

• Anti-skid on Barrier plate.

  Yes

  No

  N/A

• Is barrier plate level when down?

  Yes

  No

  N/A

• Is motor and gearbox securely fastened?

  Yes

  No

  N/A

• Does gearbox have sufficient oil?

  Yes

  No

  N/A

• Are pins and bushings showing signs of wear?

  Yes

  No

  N/A

• Does barrier complete E-up cycle in 1.5 seconds?

  Yes

  No

  N/A

• Is E-Up button in place and in good condition?

  Yes

  No

  N/A

• Does barrier E-Up reset operate?

  Yes

  No

  N/A

• Does barrier complete up-cycle in 3.5 seconds?

  Yes

  No

  N/A

• Does barrier complete down-cycle in 3-10 seconds?

  Yes

  No

  N/A

• Does barrier require up-speed adjustment?

  Yes

  No

  N/A

• Does barrier require down-speed adjustment?

  Yes

  No

  N/A

• Are housing door, handle and lock in place and in good condition?

  Yes

  No

  N/A

• Is gate arm system in good condition?

  Yes

  No

  N/A

• Is gate arm boom in good condition?

  Yes

  No

  N/A

• Clean around and under gate plate.

  Yes

  No

  N/A

• Are E-up light and alarm in place and fucntioning properly?

  Yes

  No

  N/A

• Does remote panel operate?

  Yes

  No

  N/A

• Does down limit switch work properly?

  Yes

  No

  N/A

• Is power key in place?

  Yes

  No

  N/A

• Is up button in place and in good condition?

  Yes

  No

  N/A

• Is down button in place and in good condition?

  Yes

  No

  N/A

• Does power light come on?

  Yes

  No

  N/A

• Is red indicating light operational?

  Yes

  No

  N/A

• Is Reset Key Switch in good condition?

  Yes

  No

  N/A

• Grease hinges if needed (i.e. noisy).

  Yes

  No

  N/A

• Does CPU Computer operate properly?

  Yes

  No

  N/A

• Are Motor Relays in place and in good condition.

  Yes

  No

  N/A

• Does Relay Light work properly?

  Yes

  No

  N/A

• Clean Control Panel.

  Yes

  No

  N/A

• Are Safety Loop Detectors Present and in proper operating condition?

  Yes

  No

  N/A

• Are safety loops sealed properly?

  Yes

  No

  N/A

• Front loop

  Yes

  No

  N/A

• Rear loop

  Yes

  No

  N/A

• Are traffic lights operating properly?

  Yes

  No

  N/A

• Red light

  Yes

  No

  N/A

• Amber light

  Yes

  No

  N/A

• Is Master Panel in good operating condition?

  Yes

  No

  N/A

• Is Master Panel Power Key present?

  Yes

  No

  N/A

• Power key

  Yes

  No

  N/A

• E-Up button

  Yes

  No

  N/A

• Reset Key

  Yes

  No

  N/A

• Up button

  Yes

  No

  N/A

• Down button

  Yes

  No

  N/A

• Is Power Light in good operating condition?

  Yes

  No

  N/A

• Red Indicating Light

  Yes

  No

  N/A

• Amber Indicating Light

  Yes

  No

  N/A

• Green Indicating Light

  Yes

  No

  N/A

• Is User Manual available on site (must verify by locating)

  Yes

  No

  N/A

• UPDATE PM LOG ON SITE. Take copy of entry and attach to this report.

  Yes

  No

  N/A

Signature Acknowledgement

• ELECTRONIC SIGNATURE ACKNOWLEDGE, I AGREE THAT MY ELECTRONIC SIGNATURE IS A LEGALLY BINDING EQUIVALENT TO MY HANDWRITTEN SIGNATURE. WHENEVER I EXECUTE AN ELECTRONIC SIGNATURE, IT HAS THE SAME VALIDITY AND MEANING AS MY HANDWRITTEN SIGNATURE. I WILL NOT AT ANY TIME IN THE FUTURE, REPUDIATE THE MEANING OF MY ELECTRONIC SIGNATURE OR CLAIM THAT MY ELECTRONIC SIGNATURE IS NOT LEGALLY BINDING.

• End User Representative:

  Sign

• Nasatka Representative:

  Sign