Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

General Info

  • Add location
  • Equipment Serial Number/Location:

Preventative Maintenance Checklist

  • Describe general barrier appearance.

  • Clean Hinge Areas.

  • Stop Decal on the front of barrier.

  • Anti-skid on Barrier plate.

  • Is barrier plate level when down?

  • Is motor and gearbox securely fastened?

  • Does gearbox have sufficient oil?

  • Are pins and bushings showing signs of wear?

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

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

  • Does barrier E-Up reset operate?

  • Does barrier complete up-cycle in 3.5 seconds?

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

  • Does barrier require up-speed adjustment?

  • Does barrier require down-speed adjustment?

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

  • Is gate arm system in good condition?

  • Is gate arm boom in good condition?

  • Clean around and under gate plate.

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

  • Does remote panel operate?

  • Does down limit switch work properly?

  • Is power key in place?

  • Is up button in place and in good condition?

  • Is down button in place and in good condition?

  • Does power light come on?

  • Is red indicating light operational?

  • Is Reset Key Switch in good condition?

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

  • Does CPU Computer operate properly?

  • Are Motor Relays in place and in good condition.

  • Does Relay Light work properly?

  • Clean Control Panel.

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

  • Are safety loops sealed properly?

  • Front loop

  • Rear loop

  • Are traffic lights operating properly?

  • Red light

  • Amber light

  • Is Master Panel in good operating condition?

  • Is Master Panel Power Key present?

  • Power key

  • E-Up button

  • Reset Key

  • Up button

  • Down button

  • Is Power Light in good operating condition?

  • Red Indicating Light

  • Amber Indicating Light

  • Green Indicating Light

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

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

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:

  • Nasatka Representative:

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.