Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

VBS Board Programming Options - FILL OUT FORM COMPLETELY, DO NOT LEAVE ANY QUESTIONS "BLANK' OR UN-ANSWERED" (TAKE PICTURES IF POSSIBLE)

Record Timers (in seconds)

  • Barrier Unsecure Time

  • Barreier Secure Time

  • Barrier EFO Time

  • Gate Arm Up Time

  • Gate Arm Down Time

  • Door/Gate Time

  • Unsecure Warning Horn (default is 60 Seconds)

  • Enter any Additional Comment. Take Pictures.

VBS Board - Advanced Programming

  • Gravity Unsecure

  • EFO Secure Valve

  • Re-Secure Retry

  • Motor Run for Secure

  • Gate Arm Used

  • Auto Re-Secure Loop

  • Barrier Unsecure Warning

  • Safety Loops

  • Safety Loop 1

  • Safety Loop 2

  • Safety Loop 3

  • Warning Horn Mode

  • Card Reader Mode

  • Traffic Light Red

  • Enter any Additional Comment. Take Pictures.

ELECTRONIC SIGNATURE ACKNOWLEDGEMENT

ELECTRONIC SIGNATURE ACKNOWLEDGE, I agree that my Electronic signature is a Legally and 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 furture, REPUDIATE the meaning of my Electronic Signature or Claim that my Electronic Signature is not Legally Binding.

  • Nasatka Representive Signature

  • Customer Representive or Authorized Representive Signature

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.