inspElevTractionReport VA Form 10-6167.pdf
VA Form PDF 159 KB Posted
- Solicitation number
- 36C24227Q0041
About this file
This is a Traction Elevator Inspection Report form used to document the comprehensive inspection and testing of traction elevators in buildings in accordance with ASME A17.1 code standards.
The form captures detailed elevator identification information including building name, address, elevator number, capacity, speed, and machine type (overhead geared, gearless, winding drum, or basement geared). Section 1.0 documents critical test data such as full load and empty speeds in both directions, motor voltage and amperage readings at various load conditions, safety device performance including governor trip speeds, overspeed switch activation, buffer testing, and door operation speeds and closing forces. The inspector records pass/fail results for a one-hour continuous run test and motor temperature monitoring. Sections 2.0 through 6.0 systematically evaluate the machine room (headroom, lighting, fire extinguishers, electrical systems, brake function), hoistway interior (enclosure integrity, doors, lighting, guide rails, buffers, terminal stopping devices), exterior car components (ropes, crosshead, safety devices), interior car features (doors, controls, lighting, emergency systems), and hall fixtures (lanterns, call buttons, emergency communications, firefighter controls). Each inspection item offers pass/fail/not applicable options. The form includes spaces for recording findings related to earthquake inspection requirements, smoke and heat detectors, and sprinkler systems. A comments section allows inspectors to note specific code references for deficiencies. The inspector signs, dates, and records their QEI-1 certification number, along with company information and the applicable ASME code edition used for the inspection.
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Other versions and copies of VA Form 10-6167
| File | Revision | Posted | Attached to |
|---|---|---|---|
| VA Form 10-6167 Report of Test of Elevator Governor and Safety Devices.docx | Revision not stated | H399--Elevator Inspection Service |
Who attaches VA Form 10-6167
Other files
| File | Type | Posted |
|---|---|---|
| 36C24227Q0041 0001.docx | DOCX document | |
| VA Elevator Inspection Questions and Answers-Amended .xlsx | XLSX spreadsheet | |
| Wage Determination.pdf | ||
| VA Elevator Inspection Questions and Answers.xlsx | XLSX spreadsheet | |
| Elevator List.docx | DOCX document | |
| 36C24227Q0041_1.docx | DOCX document |
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Text version
INSPECTOR SIGN___________________BUILDING NAME/#____________________________ELEVATOR#________ November 1, 2023 Page 1 of 6
TRACTION ELEVATOR INSPECTION REPORT
BUILDING NAME:_______________________________________________________________________________
BUILDING NUMBER:___________________________ELEVATOR NUMBER:_____________________________
ADDRESS:_____________________________________________________________________________________
BUILDING REPRESENTATIVE:______________________________________________________________________
CONTACT NUMBER:_____________________________________________________________________________
DATE OF INSPECTON:_________________________ ASME A17.1 CODE YEAR:__________________________
TYPE OF ELEVATOR: PASSENGER____ SERVICE____ FREIGHT____ CARTLIFT____ DUMBWAITER____
MATERIAL LOADING CLASS: A___ B____ C1____ C2____ C3____
MACHINE: OVERHEAD GEARED____ GEARLESS____ WINDING DRUM____ BASEMENT GEARED____
MANUFACTURER:______________________________________________________________________
CAPACITY (LBS):________________________ CONTRACT SPEED(FPM):_______________________
1.0 ELEVATOR TEST DATA
1.1 FULL LOAD SPEED: UP____ DOWN_____ EMPTY SPEED: UP_____ DOWN_____
1.2 MOTOR VOLTS: UP DOWN MOTOR AMPS: UP DOWN
FULL LOAD: ______ _______ FULL LOAD: ______ _______
BALANCE LOAD: ______ _______ BALANCE LOAD: ______ _______
EMPTY CAR: ______ _______ EMPTY CAR: ______ _______
1.3 TYPE OF SAFETY: A______ B______ C______
CAR SLIDE DISTANCE:____________ COUNTERWEIGHT SLIDE DISTANCE:___________
1.4 GOVERNOR TRIP SPEED: CAR_________ COUNTERWEIGHT________
1.5 OVERSPEED SWITCH TRIP SPEED: CAR______ COUNTERWEIGHT________
1.6 SPEED REDUCING SWITCH: CAR________ COUNTERWEIGHT________
1.7 GOVERNOR ROPE PULL THROUGH FORCE (LBF): CAR_______ COUNTERWEIGHT________
1.8 LOWER AND HOLD WITH 125% RATED LOAD: PASS______ FAIL______
1.9 UNINTENDED MOTION DEVICE STOPPING DISTANCE: 125% LOAD DOWN_______EMPTY CAR UP_______
1.10 OIL BUFFER TEST: CAR FULL LOAD PASS____FAIL____ COUNTERWEIGHT EMPTY CAR PASS____ FAIL___
1.11 OIL BUFFER RETURN TEST: CAR BUFFER-PASS____FAIL____ COUNTERWEIGHT PASS____ FAIL____
1.12 ONE HOUR RUN TEST: PASS____ FAIL____ MOTOR TEMPERATURE: START______ FINISH______
1.13 DOOR SPEED (SEC): CLOSE______ OPEN______ CLOSING FORCE (LBF)_______
November 1, 2023 Page 2 of 6
2.0 ELEVATOR MACHINE ROOM
2.1 ACCESS TO MACHINE ROOM PASS____ FAIL____ N/A____
2.2 HEADROOM (7 FEET MINIMUM) PASS____ FAIL____ N/A____
2.3 LIGHTING AND GFCI RECEPTACLES PASS____ FAIL____ N/A____
2.4 MACHINE SPACE PASS____ FAIL____ N/A____
2.5 HOUSEKEEPING – CLEANED AND PAINTED PASS____ FAIL____ N/A____
2.6 HVAC – VENTILATION PASS____ FAIL____ N/A____
2.7 FIRE EXTINGUISHER PASS____ FAIL____ N/A____
2.8 GUARDS ON EQUIPMENT PASS____ FAIL____ N/A____
2.9 PIPE, DUCT, WIRING AND BUSHINGS PASS____ FAIL____ N/A____
2.10 NUMBER EQUIPMENT PASS____ FAIL____ N/A____
2.11 FUSED DISCONNECT – SHUNT TRIP BREAKER PASS____ FAIL____ N/A____
2.12 CONTROLLER FUSES AND OVERLOADS PASS____ FAIL____ N/A____
2.13 BONDING WIRE AND GROUNDING PASS____ FAIL____ N/A____
2.14 INSPECTION CONTROL PASS____ FAIL____ N/A____
2.15 ABSORPTION OF REGENERATIVE DRIVE PASS____ FAIL____ N/A____
2.16 GOVERNOR, OVERSPEED SWITCH TESTED AND SEALED PASS____ FAIL____ N/A____
2.17 CODE DATA PLATE PASS____ FAIL____ N/A____
2.18 DRIVE MACHINE AND SHEAVE PASS____ FAIL____ N/A____
2.19 DRIVE MACHINE BRAKE PASS____ FAIL____ N/A____
2.20 WINDING DRUM MACHINE, SLACK ROPE SWITCH AND ROPE FASTENINGPASS____ FAIL____ N/A____
2.21 GEARS, BEARINGS AND FLEXIBLE COUPLINGS PASS____ FAIL____ N/A____
2.22 MOTOR GENERATOR SET PASS____ FAIL____ N/A____
2.23 ROPE GRIPPER/SECONDARY BRAKE PASS____ FAIL____ N/A____
2.24 SECONDARY LEVEL AND DEFLECTOR SHEAVES PASS____ FAIL____ N/A____
2.25 DEADEND HITCH PLATES PASS____ FAIL____ N/A____
2.26 MAINTENANCE CONTROL PROGRAM AND RECORDS PASS____ FAIL____ N/A____
2.27 MONTHLY FIRE SERVICE TEST LOG PASS____ FAIL____ N/A____
2.28 EMERGENCY POWER OPERATION (FULL LOAD IN CAR) PASS____ FAIL____ N/A____
2.29 EARTHQUAKE INSPECTION AND TESTS PASS____ FAIL____ N/A____
2.30 SMOKE DETECTORS_____ HEAT DETECTORS_____ SPRINKLERS_____ PASS____ FAIL____ N/A____
3.0 ELEVATOR HOISTWAY – INSIDE
3.1 ACCESS TO HOISTWAY – CARTOP AND PIT PASS____ FAIL____ N/A____
November 1, 2023 Page 3 of 6
3.2 HOISTWAY AND PIT LIGHTING PASS____ FAIL____ N/A____
3.3 HOISTWAY ENCLOSURE PASS____ FAIL____ N/A____
3.4 HOISTWAY DEVIDER BEAMS AND LEDGES PASS____ FAIL____ N/A____
3.5 ENTRANCE FRAMES (FULLY GROUTED) PASS____ FAIL____ N/A____
3.6 DUST COVERS2, FACIAS, TOP AND BOTTOM SHEAR GUARDS PASS____ FAIL____ N/A____
3.7 VISION PANELS PASS____ FAIL____ N/A____
3.8 HOISTWAY DOORS PASS____ FAIL____ N/A____
3.9 HOISTWAY DOOR LOCKING DEVICES PASS____ FAIL____ N/A____
3.10 MECHANICAL HOISTWAY DOOR CLOSURE PASS____ FAIL____ N/A____
3.11 EMERGENCY DOORS IN BLIND HOISTWAY PASS____ FAIL____ N/A____
3.12 HOISTWAY VENTILATION PASS____ FAIL____ N/A____
3.13 TRAVELING CABLE SUSPENSION PASS____ FAIL____ N/A____
3.14 TOP OF COUNTERWEIGHT CLEARANCE AND RUNBY PASS____ FAIL____ N/A____
3.15 BOTTOM OF CAR CLEARANCE, RUNBY AND REFUGE SPACE PASS____ FAIL____ N/A____
3.16 COUNTERWEIGHT, FRAME AND ROLLER GUIDES PASS____ FAIL____ N/A____
3.17 COUNTERWEIGHT SHEAVE OR SHACKLES AND HITCH PLATE PASS____ FAIL____ N/A____
3.18 COUNTERWEIGHT SAFETIES PASS____ FAIL____ N/A____
3.19 CAR OVERHEAD AND DEFLECTOR SHEAVE CLEARANCE PASS____ FAIL____ N/A____
3.20 NORMAL TERMINAL STOPPING DEVICES PASS____ FAIL____ N/A____
3.21 FINAL TERMINAL STOPPING DEVICES PASS____ FAIL____ N/A____
3.22 CAR AND COUNTERWEIGHT BUFFERS AND TAGS PASS____ FAIL____ N/A____
3.23 PIT STOP SWITCHES PASS____ FAIL____ N/A____
3.24 GOVERNOR ROPE TENSION SHEAVE PASS____ FAIL____ N/A____
3.25 GUIDE RAILS, BRACKETS AND FASTENERS PASS____ FAIL____ N/A____
3.26 COMPENSATION CHAINS – ROPES AND SHEAVE PASS____ FAIL____ N/A____
3.27 FLOOR NUMBERS ANS EMERGENCY IDENTIFICATION PASS____ FAIL____ N/A____
3.28 PIPE, DUCT, WIRING AND BUSHINGS PASS____ FAIL____ N/A____
3.29 EARTHQUAKE INSPECTION AND TESTS PASS____ FAIL____ N/A____
3.30 SMOKE DETECTORS_____ HEAT DETECTORS_____ SPRINKLERS_____ PASS____ FAIL____ N/A____
4.0 ELEVATOR CAR – OUTSIDE
4.1 CROSSHEAD DATA, HOIST ROPE AND GOVERNOR ROPE TAGS PASS____ FAIL____ N/A____
4.2 STOP SWITCH PASS____ FAIL____ N/A____
4.3 LIGHT AND GFCI RECEPTACLES – TOP AND BOTTOM PASS____ FAIL____ N/A____
November 1, 2023 Page 4 of 6
4.4 CARTOP OPERATING DEVICE PASS____ FAIL____ N/A____
4.5 DOOR REOPENING DEVICE PASS____ FAIL____ N/A____
4.6 DOOR OPENING RESTRICTOR PASS____ FAIL____ N/A____
4.7 CLEARANCE, REFUGE SPACE AND CARTOP RAILING PASS____ FAIL____ N/A____
4.8 CAR LEVELING DEVICE PASS____ FAIL____ N/A____
4.9 CARTOP EMERGENCY EXIT AND SAFETY SWITCH PASS____ FAIL____ N/A____
4.10 ELEVATOR NUMBER – TOP, BOTTOM AND COUNTERWEIGHT GUARD PASS____ FAIL____ N/A____
4.11 PIPE, DUCT, WIRING AND BUSHINGS PASS____ FAIL____ N/A____
4.12 HOISTWAY RUNNING CLEARANCE PASS____ FAIL____ N/A____
4.13 CAR DOOR OPERATOR PASS____ FAIL____ N/A____
4.14 TRAVELING CABLE SUSPENSION AND RUNNING CLEARANCE PASS____ FAIL____ N/A____
4.15 CROSSHEAD, SIDE STILES AND SAFETY PLANK PASS____ FAIL____ N/A____
4.16 CAR SAFETIES PASS____ FAIL____ N/A____
4.17 GOVERNOR ROPE AND RELEASE CARRIER PASS____ FAIL____ N/A____
4.18 HOIST ROPES, CARTOP SHEAVE OR SHACKLES AND HITCH PLATE PASS____ FAIL____ N/A____
4.19 CAR PLATFORM GUARD – TOE GUARD PASS____ FAIL____ N/A____
5.0 ELEVATOR CAR – INSIDE
5.1 CAR DOOR OR GATE PASS____ FAIL____ N/A____
5.2 DOOR CLOSING FORCE PASS____ FAIL____ N/A____
5.3 POWER OPENING OF DOOR OR GATE PASS____ FAIL____ N/A____
5.4 POWER CLOSING OF DOOR OR GATE PASS____ FAIL____ N/A____
5.5 CAR ENCLOSURE, INTERIOR FINISHES, SILL, FLOOR AND CEILING PASS____ FAIL____ N/A____
5.6 CAR VISION PANELS AND GLASS DOORS PASS____ FAIL____ N/A____
5.7 STOP SWITCHES PASS____ FAIL____ N/A____
5.8 OPERATING CONTROL DEVICES PASS____ FAIL____ N/A____
5.9 CAR LIGHTING AND GFCI RECEPTICLE PASS____ FAIL____ N/A____
5.10 EMERGENCY LIGHT AND ALARM PASS____ FAIL____ N/A____
5.11 EMERGENCY EXIT SECURED FROM OUTSIDE PASS____ FAIL____ N/A____
5.12 VENTILATION PASS____ FAIL____ N/A____
5.13 ELEVATOR NUMBER PASS____ FAIL____ N/A____
5.14 DATA PLATE: CAPACITY, LOADING CLASS AND NUMBER OF PASSENGER PASS____ FAIL____ N/A____
5.15 SIGNAGE AND BRAILLE PLATES PASS____ FAIL____ N/A____
5.16 MEDICAL EMERGENCY PASS____ FAIL____ N/A____
November 1, 2023 Page 5 of 6
5.17 CAR RIDE QUALITY PASS____ FAIL____ N/A____
5.18 EARTHQUAKE INSPECTION AND TEST PASS____ FAIL____ N/A____
5.19 FIREFIGHTER’S PHASE 2 OPERATION PASS____ FAIL____ N/A____
6.0 ELEVATOR HALL FIXTURES AND HOISTWAY ENTRANCES
6.1 HALL LANTERNS PASS____ FAIL____ N/A____
6.2 POSITIONS INDICATORS PASS____ FAIL____ N/A____
6.3 HALL CALL PUSH BUTTONS PASS____ FAIL____ N/A____
6.4 COMMUNICATION (LIGHT ANNUNCIATOR AND KEY SWITCH) PASS____ FAIL____ N/A____
6.5 MEDICAL EMERGENCY CALL – KEY SWITCH OR CARD READER PASS____ FAIL____ N/A____
6.6 BRAILE PLATES AND EMERGENCY EVACUATION PLATES PASS____ FAIL____ N/A____
6.7 ELEVATOR NUMBER ON ENTRANCE FRAMES PASS____ FAIL____ N/A____
6.8 FIREFITHER’S PHASE 1 OPERATION AND INDICATOR LIGHT PASS____ FAIL____ N/A____
6.9 SMOKE DETECTORS______HEAT DETECTORS______SPRINKLERS______ PASS____ FAIL____ N/A____
6.10 EMERGNECY POWER INDICATOR LIGHT PASS____ FAIL____ N/A____
6.11 EMERGENCY POWER SELECTOR KEY SWITCH PASS____ FAIL____ N/A____
ITEM # COMMENT CODE REFERENCE
November 1, 2023 Page 6 of 6
ITEM # COMMENT CODE REFERENCE
COMPANY NAME:________________________________
ADDRESS:_______________________________________
CITY, STATE, ZIP: _________________________________
INSPECTOR’S QEI-1:#______________________________
PRINT NAME:____________________________________
SIGNATURE:_____________________________________
DATE OF INSPECTION_________________
CODE EDITION_______________________
PASS_____________FAIL______________
| TRACTION ELEVATOR INSPECTION REPORT |
| ELEVATOR TEST DATA |
| ELEVATOR MACHINE ROOM |
| ELEVATOR HOISTWAY – INSIDE |
| ELEVATOR CAR – OUTSIDE |
| ELEVATOR CAR – INSIDE |
| ELEVATOR HALL FIXTURES AND HOISTWAY ENTRANCES |
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