2024 Elevator Inspections Portfolio.pdf

PDF 3 MB Posted Aug 26, 2024

Attached to: J035--All-Inclusive Elevator Maintenance and Repair Services Federal contract opportunity
Solicitation number: 36C24424Q0830
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 4

About this file

Written by GovTribe AI · Aug 26, 2024

This document is a combined synopsis/solicitation for commercial items for J035--All-Inclusive Elevator Maintenance and Repair Services at the Wilkes Barre VAMC. It is a Request for Quote (RFQ) issued by the Department of Veterans Affairs, with Solicitation Number 36C24424Q0830. The Contracting Office is seeking to establish an Indefinite Delivery/Indefinite Quantity (IDIQ) contract for a 5-year period to provide elevator maintenance and repair services. This is a Service-Disabled Veteran Owned Small Business (SDVOSB) set-aside with a NAICS code of 238290. Quotes are due by 12:00 PM EST on August 23, 2024. The solicitation includes a Performance Work Statement outlining the requirements, and a Pricing Sheet for offerors to complete. A site visit is scheduled for July 31, 2024. The contract will be awarded on a lowest price technically acceptable basis.

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Other files attached to J035--All-Inclusive Elevator Maintenance and Repair Services, newest first.
File	Type	Posted
Elevator Services Report 2022-2024.xls.xlsx	XLSX spreadsheet	Aug 26, 2024
36C24424Q0830 0002.pdf	PDF	Aug 26, 2024
36C24424Q0830 0002_1.docx	DOCX document	Aug 26, 2024
36C24424Q0830 0001 Amendment.pdf	PDF	Aug 16, 2024
36C24424Q0830 0001_1.docx	DOCX document	Aug 16, 2024
WD 1997-0340 Rev 38 dtd 01-23-2024.pdf	PDF	Jul 24, 2024
RFQ 36C24424Q0830 Pricing Sheet.xlsx	XLSX spreadsheet	Jul 24, 2024
36C24424Q0830 RFQ Wilkes-Barre.pdf	PDF	Jul 24, 2024

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Checklist and Report for Inspection of Electric Elevators

GENERAL NOTES:

(a) See ASME A17.2 for detailed Code requirements. Numbering is tied to the numbering on A17.2 sections.

(b) OK = Meets requirements NG = Insert number to identify comment on back of this checklist NA = Not Applicable

Routine Inspection and Test Periodic Inspection and Test Acceptance Inspection and Test

Address: _______________________________________________________________________________________________________________________________________________________

ID No.: ___________________________________________________________________________ Code Edition: ________________________________________________________________

Passenger Rated Load: _________________________ lb or kg Inspected by: ______________________________________________________________

Freight Class: __________________________________________ Signature: ____________________________________________________________________

Speed: ________________________ fpm or m/s Certifi cate No: _______________ Certifying Organization: ___________________________________________________

OK NG NA

1 INSIDE OF CAR

1.1 Door reopening device

1.2 Stop switches

1.3 Operating control devices

1.4 Sills and car fl oor

1.5 Car lighting and receptacles

1.6 Car emergency signal

1.7 Car door or gate

1.8 Door closing force

1.9 Power closing of doors or gates

1.10 Power opening of doors or gates

1.11 Car vision panels and glass car doors

1.12 Car enclosure

1.13 Emergency exit

1.14 Ventilation

1.15 Signs and operating device symbols

1.16 Rated load, platform area and data plate

1.17 Standby power operation

1.18 Restricted opening of car or hoistway doors

1.19 Car ride

1.20 Earthquake inspection and tests

(seismic risk zone 2 or greater)

2 MACHINE ROOM

2.1 Access to machine space

2.2 Headroom

2.3 Lighting and receptacles

2.4 Machine space

2.5 Housekeeping

2.6 Ventilation

2.7 Fire extinguisher

2 MACHINE ROOM (continued) OK NG NA

2 MACHINE ROOM (continued)

2.8 Pipes, wiring and ducts

2.9 Guarding of exposed auxiliary equipment

2.10 Numbering of elevators, machines, controllers and disconnect switches

2.11 Disconnecting means and control

2.12 Controller wiring, fuses, grounding, etc.

2.13 Governor, overspeed switch and seal

2.14 Code data plate

2.15 Static control

2.16 Overhead beam and fastenings

2.17 Drive machine brake

2.18 Traction drive machines

2.19 Gears, bearings and fl exible couplings

2.20 Winding drum machine and slack cable rope

device, stop motion switch and rope fastening

2.21 Belt or chain drive machine

2.22 Motor generator

2.23 Absorption of regenerated power

2.24 AC drives from a DC source

2.25 Traction sheaves

2.26 Secondary and defl ector sheaves

2.27 Rope fastenings

2.28 Terminal stopping devices

2.29 Car and counterweight safeties

2.38 Roped water hydraulic elevators

2.40 MCP and Maintenance Records

2.41 Static Control

2.42 Earthquake inspection and tests

(continued on page 2)

(from Code Data Plate)

3 TOP OF CAR

3.1 Top of car stop switch

3.2 Car top light and outlet

3.3 Top of car operating device

3.4 Top of car clearance, refuge space

and standard railing

3.5 Normal terminal stopping device

3.6 Final and emergency terminal stopping devices

3.7 Car leveling and anticreep devices

3.8 Top emergency exit

3.9 Floor and emergency identifi cation numbering

3.10 Hoistway construction

3.11 Hoistway smoke control

3.12 Pipes, wiring and ducts

3.13 Windows, projections, recesses and setbacks

3.14 Hoistway clearances

3.15 Multiple hoistways

3.16 Traveling cables and junction boxes

3.17 Door and gate equipment

3.18 Car frame and stiles

3.19 Guide rails, fastenings and equipment

3.20 Governor rope

3.21 Governor releasing carrier

3.22 Wire rope fastening and hitch plate

3.23 Suspension means

3.27 Crosshead data plate and rope data tags

3.28 Counterweight and counterweight buffer

3.29 Counterweight safeties

3.30 Speed test

3.33 Compensating ropes and chains

3.34 Earthquake inspection and tests

4 OUTSIDE HOISTWAY

4.1 Car platform guard

4.2 Hoistway doors

4.3 Vision panels

4.4 Hoistway door locking devices

4.5 Access to hoistway

4.6 Power closing of hoistway doors

4.7 Sequence operation

4.8 Hoistway enclosure

4.9 Elevator parking device

4.10 Emergency doors in blind hoistways

4.12 Standby power selection switch

5 PIT

5.1 Pit access, lighting, stop switch and condition

5.2 Bottom clearance, runby and minimum

refuge space

5.3 Final and emergency terminal stopping device

5.4 Normal terminal stopping devices

5.5 Traveling cables

5.6 Governor rope tension device

5.7 Car frame and platform

5.8 Car and counterweight safeties

and guiding members

5.9 Buffers and emergency terminal

speed limiting devices

5.10 Compensating chains, ropes and sheaves

5.12 Car buffer

5.13 Guiding members (rails, rollers, slides)

5.16 Earthquake inspection and tests

6 FIREFIGHTERS’ SERVICE (FEO)

6.1 A17.1b-1973 through A17.1b-1980

6.2 A17.1-1981 through A17.1b-1983

6.3 A17.1-1984 through A17.1a-1988 and A17.3

6.4 A17.1b-1989 through A17.1b-2000

6.5 A17.1-2000 and B44-00

6.6 A17.1-2004 and B44-04

6.7 A17.1-2007 and B44-07

6.8 A17.1-2010 and B44-10

6.9 A17.1-2013 and B44-13

Comments: ______________________________________________________________

Date:

Address: Wilkes-Barre VAMC 1111 East End Blvd. Wilkes-Barre, PA 18711

ID No: P1 Silver Elevator

Rated Load: 4000 lbs

Routine: Off

Periodic: On

Acceptance: Off

Inspected By: George Boone

Certifying Organization: NAESA

Code Edition: 2016

Certificate No: C-6615

Speed: 500 fpm

Class: Passenger

Passenger: On

Freight: Off

1 OK: On

1 NG: Off

1 NA: Off

12 OK: Off

12 NG: Off

12 NA: On

10 OK: Off

10 NG: Off

10 NA: On

9 OK: On

9 NG: Off

9 NA: Off

8 OK: On

8 NG: Off

8 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

4 OK: On

4 NG: Off

4 NA: Off

3 OK: Off

3 NG: Off

3 NA: On

2 OK: On

2 NG: Off

2 NA: Off

1 OK: Off

1 NG: Off

1 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

10 OK: Off

10 NG: Off

10 NA: On

11 OK: Off

11 NG: Off

11 NA: On

12 OK: Off

12 NG: Off

12 NA: On

13 OK: Off

13 NG: Off

13 NA: On

14 NG: Off

14 NA: On

14 OK: Off

15 OK: Off

15 NG: Off

15 NA: On

16 OK: Off

16 NG: Off

16 NA: On

17 OK: Off

17 NG: Off

17 NA: On

18 OK: Off

18 NG: Off

18 NA: On

19 OK: Off

19 NG: Off

19 NA: On

20 NG: Off

20 OK: Off

21 OK: Off

21 NG: Off

21 NA: On

22 OK: Off

22 NG: Off

22 NA: On

23 OK: Off

23 NG: Off

23 NA: On

27 OK: Off

27 NG: Off

27 NA: On

28 OK: Off

28 NG: Off

28 NA: On

29 OK: Off

29 NG: Off

20 NA: On

29 NA: On

30 OK: Off

30 NG: Off

30 NA: On

34 OK: Off

34 NG: Off

34 NA: On

33 OK: Off

33 NG: Off

33 NA: On

1 OK: Off

1 NG: Off

1 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

1 OK: Off

1 NG: Off

1 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

12 OK: Off

12 NG: Off

12 NA: On

13 OK: Off

13 NG: Off

13 NA: On

16 OK: Off

16 NG: Off

16 NA: On

10 OK: Off

10 NG: Off

10 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

8 OK: On

8 NG: Off

8 NA: Off

9 OK: On

9 NG: Off

9 NA: Off

10 OK: On

10 NG: Off

10 NA: Off

11 OK: On

11 NG: Off

11 NA: Off

12 OK: On

12 NG: Off

12 NA: Off

38 OK: Off

38 NG: Off

38 NA: On

40 OK: On

40 NG: Off

40 NA: Off

41 OK: Off

41 NG: Off

41 NA: On

42 NG: Off

42 NA: On

42 OK: Off

1 OK: On

1 NG: Off

1 NA: Off

2 OK: On

2 NG: Off

2 NA: Off

3 NA: Off

3 OK: On

3 NG: Off

4 OK: On

4 NG: Off

4 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

29 OK: On

29 NG: Off

29 NA: Off

28 OK: On

28 NG: Off

28 NA: Off

27 OK: On

27 NG: Off

27NA: Off

26 OK: On

26 NG: Off

26 NA: Off

25 OK: On

25 NG: Off

25 NA: Off

24 OK: Off

24 NG: Off

24 NA: On

13 NA: Off

14 NG: Off

14 NA: Off

13 OK: On

13 NG: Off

14 OK: On

23 OK: Off

23 NG: Off

23 NA: On

22 OK: On

22 NG: Off

22 NA: Off

21 OK: Off

21 NG: Off

21 NA: On

20 OK: Off

20 NG: Off

20 NA: On

19 OK: On

19 NG: Off

19 NA: Off

18 OK: On

18 NG: Off

18 NA: Off

17 OK: On

17 NG: Off

17 NA: Off

16 OK: On

16 NG: Off

16 NA: Off

15 OK: On

15 NG: Off

15 NA: Off

1 OK: On

1 NG: Off

1 NA: Off

2 OK: Off

2 NG: Off

2 NA: On

3 OK: On

3 NG: Off

3 NA: Off

4 OK: On

4 NG: Off

4 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

8 OK: On

8 NG: Off

8 NA: Off

9 OK: On

9 NG: Off

9 NA: Off

10 OK: On

10 NG: Off

10 NA: Off

11 OK: Off

11 NG: Off

11 NA: On

12 OK: On

12 NG: Off

12 NA: Off

13 OK: On

13 NG: Off

13 NA: Off

14 OK: On

14 NG: Off

14 NA: Off

15 OK: On

15 NG: Off

15 NA: Off

16 OK: On

16 NG: Off

16 NA: Off

17 OK: Off

17 NG: Off

17 NA: On

18 OK: On

18 NG: Off

18 NA: Off

19 OK: On

19 NG: Off

19 NA: Off

20 OK: Off

20 NG: Off

20 NA: On

Sig:

Comments: Elevator passed inspection

Notes: Comp sheave is nearing full travel, recommend shortening cables.

Date_af_date: 4/16/24

(a) See ASME A17.2 for detailed Code requirements. Numbering is tied to the numbering on A17.2 sections.

(b) OK = Meets requirements NG = Insert number to identify comment on back of this checklist NA = Not Applicable

Address: _______________________________________________________________________________________________________________________________________________________

ID No.: ___________________________________________________________________________ Code Edition: ________________________________________________________________

Passenger Rated Load: _________________________ lb or kg Inspected by: ______________________________________________________________

Freight Class: __________________________________________ Signature: ____________________________________________________________________

Speed: ________________________ fpm or m/s Certifi cate No: _______________ Certifying Organization: ___________________________________________________

1.3 Operating control devices

1.4 Sills and car fl oor

1.5 Car lighting and receptacles

1.6 Car emergency signal

1.7 Car door or gate

1.8 Door closing force

1.9 Power closing of doors or gates

1.10 Power opening of doors or gates

1.11 Car vision panels and glass car doors

1.12 Car enclosure

1.13 Emergency exit

1.14 Ventilation

1.15 Signs and operating device symbols

1.16 Rated load, platform area and data plate

1.17 Standby power operation

1.18 Restricted opening of car or hoistway doors

1.19 Car ride

2.3 Lighting and receptacles

2.4 Machine space

2.5 Housekeeping

2.10 Numbering of elevators, machines, controllers and disconnect switches

2.11 Disconnecting means and control

2.12 Controller wiring, fuses, grounding, etc.

2.13 Governor, overspeed switch and seal

2.14 Code data plate

2.15 Static control

2.16 Overhead beam and fastenings

2.17 Drive machine brake

2.18 Traction drive machines

2.19 Gears, bearings and fl exible couplings

2.20 Winding drum machine and slack cable rope

device, stop motion switch and rope fastening

2.21 Belt or chain drive machine

2.22 Motor generator

2.23 Absorption of regenerated power

2.24 AC drives from a DC source

2.25 Traction sheaves

2.26 Secondary and defl ector sheaves

2.27 Rope fastenings

2.28 Terminal stopping devices

2.29 Car and counterweight safeties

2.38 Roped water hydraulic elevators

2.40 MCP and Maintenance Records

2.41 Static Control

3.3 Top of car operating device

3.4 Top of car clearance, refuge space

and standard railing

3.5 Normal terminal stopping device

3.6 Final and emergency terminal stopping devices

3.7 Car leveling and anticreep devices

3.8 Top emergency exit

3.9 Floor and emergency identifi cation numbering

3.10 Hoistway construction

3.11 Hoistway smoke control

3.12 Pipes, wiring and ducts

3.13 Windows, projections, recesses and setbacks

3.14 Hoistway clearances

3.15 Multiple hoistways

3.16 Traveling cables and junction boxes

3.17 Door and gate equipment

3.18 Car frame and stiles

3.19 Guide rails, fastenings and equipment

3.20 Governor rope

3.21 Governor releasing carrier

3.22 Wire rope fastening and hitch plate

3.23 Suspension means

3.27 Crosshead data plate and rope data tags

3.28 Counterweight and counterweight buffer

3.29 Counterweight safeties

3.30 Speed test

3.33 Compensating ropes and chains

4.3 Vision panels

4.4 Hoistway door locking devices

4.5 Access to hoistway

4.6 Power closing of hoistway doors

4.7 Sequence operation

4.8 Hoistway enclosure

4.9 Elevator parking device

refuge space

5.3 Final and emergency terminal stopping device

5.4 Normal terminal stopping devices

5.5 Traveling cables

5.6 Governor rope tension device

5.12 Car buffer

5.13 Guiding members (rails, rollers, slides)

6.3 A17.1-1984 through A17.1a-1988 and A17.3

6.4 A17.1b-1989 through A17.1b-2000

6.5 A17.1-2000 and B44-00

6.6 A17.1-2004 and B44-04

6.7 A17.1-2007 and B44-07

Address: Wilkes-Barre VAMC 1111 East End Blvd. Wilkes-Barre, PA 18711

ID No: P2 Silver Elevator

Rated Load: 4000 lbs

Routine: Off

Periodic: On

Acceptance: Off

Inspected By: George Boone

Certifying Organization: NAESA

Code Edition: 2016

Certificate No: C-6615

Speed: 500 fpm

Class:

Passenger: On

Freight: Off

1 OK: On

1 NG: Off

1 NA: Off

12 OK: Off

12 NG: Off

12 NA: On

10 OK: Off

10 NG: Off

10 NA: On

9 OK: On

9 NG: Off

9 NA: Off

8 OK: On

8 NG: Off

8 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

4 OK: On

4 NG: Off

4 NA: Off

3 OK: Off

3 NG: Off

3 NA: On

2 OK: On

2 NG: Off

2 NA: Off

1 OK: Off

1 NG: Off

1 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

10 OK: Off

10 NG: Off

10 NA: On

11 OK: Off

11 NG: Off

11 NA: On

12 OK: Off

12 NG: Off

12 NA: On

13 OK: Off

13 NG: Off

13 NA: On

14 NG: Off

14 NA: On

14 OK: Off

15 OK: Off

15 NG: Off

15 NA: On

16 OK: Off

16 NG: Off

16 NA: On

17 OK: Off

17 NG: Off

17 NA: On

18 OK: Off

18 NG: Off

18 NA: On

19 OK: Off

19 NG: Off

19 NA: On

20 NG: Off

20 OK: Off

21 OK: Off

21 NG: Off

21 NA: On

22 OK: Off

22 NG: Off

22 NA: On

23 OK: Off

23 NG: Off

23 NA: On

27 OK: Off

27 NG: Off

27 NA: On

28 OK: Off

28 NG: Off

28 NA: On

29 OK: Off

29 NG: Off

20 NA: On

29 NA: On

30 OK: Off

30 NG: Off

30 NA: On

34 OK: Off

34 NG: Off

34 NA: On

33 OK: Off

33 NG: Off

33 NA: On

1 OK: Off

1 NG: Off

1 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

1 OK: Off

1 NG: Off

1 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

12 OK: Off

12 NG: Off

12 NA: On

13 OK: Off

13 NG: Off

13 NA: On

16 OK: Off

16 NG: Off

16 NA: On

10 OK: Off

10 NG: Off

10 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

8 OK: On

8 NG: Off

8 NA: Off

9 OK: On

9 NG: Off

9 NA: Off

10 OK: On

10 NG: Off

10 NA: Off

11 OK: On

11 NG: Off

11 NA: Off

12 OK: On

12 NG: Off

12 NA: Off

38 OK: Off

38 NG: Off

38 NA: On

40 OK: On

40 NG: Off

40 NA: Off

41 OK: On

41 NG: Off

41 NA: Off

42 NG: Off

42 NA: On

42 OK: Off

1 OK: On

1 NG: Off

1 NA: Off

2 OK: On

2 NG: Off

2 NA: Off

3 NA: Off

3 OK: On

3 NG: Off

4 OK: On

4 NG: Off

4 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

29 OK: On

29 NG: Off

29 NA: Off

28 OK: Off

28 NG: Off

28 NA: On

27 OK: On

27 NG: Off

27NA: Off

26 OK: On

26 NG: Off

26 NA: Off

25 OK: On

25 NG: Off

25 NA: Off

24 OK: Off

24 NG: Off

24 NA: On

13 NA: Off

14 NG: Off

14 NA: Off

13 OK: On

13 NG: Off

14 OK: On

23 OK: Off

23 NG: Off

23 NA: On

22 OK: On

22 NG: Off

22 NA: Off

21 OK: Off

21 NG: Off

21 NA: On

20 OK: Off

20 NG: Off

20 NA: On

19 OK: On

19 NG: Off

19 NA: Off

18 OK: On

18 NG: Off

18 NA: Off

17 OK: On

17 NG: Off

17 NA: Off

16 OK: On

16 NG: Off

16 NA: Off

15 OK: On

15 NG: Off

15 NA: Off

1 OK: On

1 NG: Off

1 NA: Off

2 OK: On

2 NG: Off

2 NA: Off

3 OK: On

3 NG: Off

3 NA: Off

4 OK: On

4 NG: Off

4 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

8 OK: On

8 NG: Off

8 NA: Off

9 OK: On

9 NG: Off

9 NA: Off

10 OK: On

10 NG: Off

10 NA: Off

11 OK: Off

11 NG: Off

11 NA: On

12 OK: On

12 NG: Off

12 NA: Off

13 OK: On

13 NG: Off

13 NA: Off

14 OK: On

14 NG: Off

14 NA: Off

15 OK: On

15 NG: Off

15 NA: Off

16 OK: On

16 NG: Off

16 NA: Off

17 OK: Off

17 NG: Off

17 NA: On

18 OK: On

18 NG: Off

18 NA: Off

19 OK: On

19 NG: Off

19 NA: Off

20 OK: Off

20 NG: Off

20 NA: On

Sig:

Comments: Elevator passed inspection

Date_af_date: 4/16/24

(a) See ASME A17.2 for detailed Code requirements. Numbering is tied to the numbering on A17.2 sections.

(b) OK = Meets requirements NG = Insert number to identify comment on back of this checklist NA = Not Applicable

Address: _______________________________________________________________________________________________________________________________________________________

ID No.: ___________________________________________________________________________ Code Edition: ________________________________________________________________

Passenger Rated Load: _________________________ lb or kg Inspected by: ______________________________________________________________

Freight Class: __________________________________________ Signature: ____________________________________________________________________

Speed: ________________________ fpm or m/s Certifi cate No: _______________ Certifying Organization: ___________________________________________________

1.3 Operating control devices

1.4 Sills and car fl oor

1.5 Car lighting and receptacles

1.6 Car emergency signal

1.7 Car door or gate

1.8 Door closing force

1.9 Power closing of doors or gates

1.10 Power opening of doors or gates

1.11 Car vision panels and glass car doors

1.12 Car enclosure

1.13 Emergency exit

1.14 Ventilation

1.15 Signs and operating device symbols

1.16 Rated load, platform area and data plate

1.17 Standby power operation

1.18 Restricted opening of car or hoistway doors

1.19 Car ride

2.3 Lighting and receptacles

2.4 Machine space

2.5 Housekeeping

2.10 Numbering of elevators, machines, controllers and disconnect switches

2.11 Disconnecting means and control

2.12 Controller wiring, fuses, grounding, etc.

2.13 Governor, overspeed switch and seal

2.14 Code data plate

2.15 Static control

2.16 Overhead beam and fastenings

2.17 Drive machine brake

2.18 Traction drive machines

2.19 Gears, bearings and fl exible couplings

2.20 Winding drum machine and slack cable rope

device, stop motion switch and rope fastening

2.21 Belt or chain drive machine

2.22 Motor generator

2.23 Absorption of regenerated power

2.24 AC drives from a DC source

2.25 Traction sheaves

2.26 Secondary and defl ector sheaves

2.27 Rope fastenings

2.28 Terminal stopping devices

2.29 Car and counterweight safeties

2.38 Roped water hydraulic elevators

2.40 MCP and Maintenance Records

2.41 Static Control

3.3 Top of car operating device

3.4 Top of car clearance, refuge space

and standard railing

3.5 Normal terminal stopping device

3.6 Final and emergency terminal stopping devices

3.7 Car leveling and anticreep devices

3.8 Top emergency exit

3.9 Floor and emergency identifi cation numbering

3.10 Hoistway construction

3.11 Hoistway smoke control

3.12 Pipes, wiring and ducts

3.13 Windows, projections, recesses and setbacks

3.14 Hoistway clearances

3.15 Multiple hoistways

3.16 Traveling cables and junction boxes

3.17 Door and gate equipment

3.18 Car frame and stiles

3.19 Guide rails, fastenings and equipment

3.20 Governor rope

3.21 Governor releasing carrier

3.22 Wire rope fastening and hitch plate

3.23 Suspension means

3.27 Crosshead data plate and rope data tags

3.28 Counterweight and counterweight buffer

3.29 Counterweight safeties

3.30 Speed test

3.33 Compensating ropes and chains

4.3 Vision panels

4.4 Hoistway door locking devices

4.5 Access to hoistway

4.6 Power closing of hoistway doors

4.7 Sequence operation

4.8 Hoistway enclosure

4.9 Elevator parking device

refuge space

5.3 Final and emergency terminal stopping device

5.4 Normal terminal stopping devices

5.5 Traveling cables

5.6 Governor rope tension device

5.12 Car buffer

5.13 Guiding members (rails, rollers, slides)

6.3 A17.1-1984 through A17.1a-1988 and A17.3

6.4 A17.1b-1989 through A17.1b-2000

6.5 A17.1-2000 and B44-00

6.6 A17.1-2004 and B44-04

6.7 A17.1-2007 and B44-07

Address: Wilkes-Barre VAMC 1111 East End Blvd. Wilkes-Barre, PA 18711

ID No: P3 Silver Elevator

Rated Load: 4000 lbs

Routine: Off

Periodic: On

Acceptance: Off

Inspected By: George Boone

Certifying Organization: NAESA

Code Edition: 2016

Certificate No: C-6615

Speed: 500 fpm

Class:

Passenger: Off

Freight: Off

1 OK: On

1 NG: Off

1 NA: Off

12 OK: Off

12 NG: Off

12 NA: On

10 OK: Off

10 NG: Off

10 NA: On

9 OK: On

9 NG: Off

9 NA: Off

8 OK: On

8 NG: Off

8 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

4 OK: On

4 NG: Off

4 NA: Off

3 OK: Off

3 NG: Off

3 NA: On

2 OK: On

2 NG: Off

2 NA: Off

1 OK: Off

1 NG: Off

1 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

10 OK: Off

10 NG: Off

10 NA: On

11 OK: Off

11 NG: Off

11 NA: On

12 OK: Off

12 NG: Off

12 NA: On

13 OK: Off

13 NG: Off

13 NA: On

14 NG: Off

14 NA: On

14 OK: Off

15 OK: Off

15 NG: Off

15 NA: On

16 OK: Off

16 NG: Off

16 NA: On

17 OK: Off

17 NG: Off

17 NA: On

18 OK: Off

18 NG: Off

18 NA: On

19 OK: Off

19 NG: Off

19 NA: On

20 NG: Off

20 OK: Off

21 OK: Off

21 NG: Off

21 NA: On

22 OK: Off

22 NG: Off

22 NA: On

23 OK: Off

23 NG: Off

23 NA: On

27 OK: Off

27 NG: Off

27 NA: On

28 OK: Off

28 NG: Off

28 NA: On

29 OK: Off

29 NG: Off

20 NA: On

29 NA: On

30 OK: Off

30 NG: Off

30 NA: On

34 OK: Off

34 NG: Off

34 NA: On

33 OK: Off

33 NG: Off

33 NA: On

1 OK: Off

1 NG: Off

1 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

1 OK: Off

1 NG: Off

1 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

12 OK: Off

12 NG: Off

12 NA: On

13 OK: Off

13 NG: Off

13 NA: On

16 OK: Off

16 NG: Off

16 NA: On

10 OK: Off

10 NG: Off

10 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

8 OK: On

8 NG: Off

8 NA: Off

9 OK: On

9 NG: Off

9 NA: Off

10 OK: On

10 NG: Off

10 NA: Off

11 OK: On

11 NG: Off

11 NA: Off

12 OK: On

12 NG: Off

12 NA: Off

38 OK: Off

38 NG: Off

38 NA: On

40 OK: On

40 NG: Off

40 NA: Off

41 OK: On

41 NG: Off

41 NA: Off

42 NG: Off

42 NA: On

42 OK: Off

1 OK: On

1 NG: Off

1 NA: Off

2 OK: On

2 NG: Off

2 NA: Off

3 NA: Off

3 OK: On

3 NG: Off

4 OK: On

4 NG: Off

4 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

29 OK: On

29 NG: Off

29 NA: Off

28 OK: Off

28 NG: Off

28 NA: On

27 OK: On

27 NG: Off

27NA: Off

26 OK: On

26 NG: Off

26 NA: Off

25 OK: On

25 NG: Off

25 NA: Off

24 OK: Off

24 NG: Off

24 NA: On

13 NA: Off

14 NG: Off

14 NA: Off

13 OK: On

13 NG: Off

14 OK: On

23 OK: Off

23 NG: Off

23 NA: On

22 OK: On

22 NG: Off

22 NA: Off

21 OK: Off

21 NG: Off

21 NA: On

20 OK: Off

20 NG: Off

20 NA: On

19 OK: On

19 NG: Off

19 NA: Off

18 OK: On

18 NG: Off

18 NA: Off

17 OK: On

17 NG: Off

17 NA: Off

16 OK: On

16 NG: Off

16 NA: Off

15 OK: On

15 NG: Off

15 NA: Off

1 OK: On

1 NG: Off

1 NA: Off

2 OK: On

2 NG: Off

2 NA: Off

3 OK: On

3 NG: Off

3 NA: Off

4 OK: On

4 NG: Off

4 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

8 OK: On

8 NG: Off

8 NA: Off

9 OK: On

9 NG: Off

9 NA: Off

10 OK: On

10 NG: Off

10 NA: Off

11 OK: Off

11 NG: Off

11 NA: On

12 OK: On

12 NG: Off

12 NA: Off

13 OK: On

13 NG: Off

13 NA: Off

14 OK: On

14 NG: Off

14 NA: Off

15 OK: On

15 NG: Off

15 NA: Off

16 OK: On

16 NG: Off

16 NA: Off

17 OK: Off

17 NG: Off

17 NA: On

18 OK: On

18 NG: Off

18 NA: Off

19 OK: On

19 NG: Off

19 NA: Off

20 OK: Off

20 NG: Off

20 NA: On

Sig:

Comments: Elevator passed inspection

Date_af_date: 4/16/24

(a) See ASME A17.2 for detailed Code requirements. Numbering is tied to the numbering on A17.2 sections.

(b) OK = Meets requirements NG = Insert number to identify comment on back of this checklist NA = Not Applicable

Address: _______________________________________________________________________________________________________________________________________________________

ID No.: ___________________________________________________________________________ Code Edition: ________________________________________________________________

Passenger Rated Load: _________________________ lb or kg Inspected by: ______________________________________________________________

Freight Class: __________________________________________ Signature: ____________________________________________________________________

Speed: ________________________ fpm or m/s Certifi cate No: _______________ Certifying Organization: ___________________________________________________

1.3 Operating control devices

1.4 Sills and car fl oor

1.5 Car lighting and receptacles

1.6 Car emergency signal

1.7 Car door or gate

1.8 Door closing force

1.9 Power closing of doors or gates

1.10 Power opening of doors or gates

1.11 Car vision panels and glass car doors

1.12 Car enclosure

1.13 Emergency exit

1.14 Ventilation

1.15 Signs and operating device symbols

1.16 Rated load, platform area and data plate

1.17 Standby power operation

1.18 Restricted opening of car or hoistway doors

1.19 Car ride

2.3 Lighting and receptacles

2.4 Machine space

2.5 Housekeeping

2.10 Numbering of elevators, machines, controllers and disconnect switches

2.11 Disconnecting means and control

2.12 Controller wiring, fuses, grounding, etc.

2.13 Governor, overspeed switch and seal

2.14 Code data plate

2.15 Static control

2.16 Overhead beam and fastenings

2.17 Drive machine brake

2.18 Traction drive machines

2.19 Gears, bearings and fl exible couplings

2.20 Winding drum machine and slack cable rope

device, stop motion switch and rope fastening

2.21 Belt or chain drive machine

2.22 Motor generator

2.23 Absorption of regenerated power

2.24 AC drives from a DC source

2.25 Traction sheaves

2.26 Secondary and defl ector sheaves

2.27 Rope fastenings

2.28 Terminal stopping devices

2.29 Car and counterweight safeties

2.38 Roped water hydraulic elevators

2.40 MCP and Maintenance Records

2.41 Static Control

3.3 Top of car operating device

3.4 Top of car clearance, refuge space

and standard railing

3.5 Normal terminal stopping device

3.6 Final and emergency terminal stopping devices

3.7 Car leveling and anticreep devices

3.8 Top emergency exit

3.9 Floor and emergency identifi cation numbering

3.10 Hoistway construction

3.11 Hoistway smoke control

3.12 Pipes, wiring and ducts

3.13 Windows, projections, recesses and setbacks

3.14 Hoistway clearances

3.15 Multiple hoistways

3.16 Traveling cables and junction boxes

3.17 Door and gate equipment

3.18 Car frame and stiles

3.19 Guide rails, fastenings and equipment

3.20 Governor rope

3.21 Governor releasing carrier

3.22 Wire rope fastening and hitch plate

3.23 Suspension means

3.27 Crosshead data plate and rope data tags

3.28 Counterweight and counterweight buffer

3.29 Counterweight safeties

3.30 Speed test

3.33 Compensating ropes and chains

4.3 Vision panels

4.4 Hoistway door locking devices

4.5 Access to hoistway

4.6 Power closing of hoistway doors

4.7 Sequence operation

4.8 Hoistway enclosure

4.9 Elevator parking device

refuge space

5.3 Final and emergency terminal stopping device

5.4 Normal terminal stopping devices

5.5 Traveling cables

5.6 Governor rope tension device

5.12 Car buffer

5.13 Guiding members (rails, rollers, slides)

6.3 A17.1-1984 through A17.1a-1988 and A17.3

6.4 A17.1b-1989 through A17.1b-2000

6.5 A17.1-2000 and B44-00

6.6 A17.1-2004 and B44-04

6.7 A17.1-2007 and B44-07

Address: Wilkes-Barre VAMC 1111 East End Blvd. Wilkes-Barre, PA 18711

ID No: P4 Silver Elevator

Rated Load: 4000 lbs

Routine: Off

Periodic: On

Acceptance: Off

Inspected By: George Boone

Certifying Organization: NAESA

Code Edition: 2016

Certificate No: C-6615

Speed: 500 fpm

Class:

Passenger: On

Freight: Off

1 OK: On

1 NG: Off

1 NA: Off

12 OK: Off

12 NG: Off

12 NA: On

10 OK: Off

10 NG: Off

10 NA: On

9 OK: On

9 NG: Off

9 NA: Off

8 OK: On

8 NG: Off

8 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

4 OK: On

4 NG: Off

4 NA: Off

3 OK: Off

3 NG: Off

3 NA: On

2 OK: On

2 NG: Off

2 NA: Off

1 OK: Off

1 NG: Off

1 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

10 OK: Off

10 NG: Off

10 NA: On

11 OK: Off

11 NG: Off

11 NA: On

12 OK: Off

12 NG: Off

12 NA: On

13 OK: Off

13 NG: Off

13 NA: On

14 NG: Off

14 NA: On

14 OK: Off

15 OK: Off

15 NG: Off

15 NA: On

16 OK: Off

16 NG: Off

16 NA: On

17 OK: Off

17 NG: Off

17 NA: On

18 OK: Off

18 NG: Off

18 NA: On

19 OK: Off

19 NG: Off

19 NA: On

20 NG: Off

20 OK: Off

21 OK: Off

21 NG: Off

21 NA: On

22 OK: Off

22 NG: Off

22 NA: On

23 OK: Off

23 NG: Off

23 NA: On

27 OK: Off

27 NG: Off

27 NA: On

28 OK: Off

28 NG: Off

28 NA: On

29 OK: Off

29 NG: Off

20 NA: On

29 NA: On

30 OK: Off

30 NG: Off

30 NA: On

34 OK: Off

34 NG: Off

34 NA: On

33 OK: Off

33 NG: Off

33 NA: On

1 OK: Off

1 NG: Off

1 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

1 OK: Off

1 NG: Off

1 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

12 OK: Off

12 NG: Off

12 NA: On

13 OK: Off

13 NG: Off

13 NA: On

16 OK: Off

16 NG: Off

16 NA: On

10 OK: Off

10 NG: Off

10 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

8 OK: On

8 NG: Off

8 NA: Off

9 OK: On

9 NG: Off

9 NA: Off

10 OK: On

10 NG: Off

10 NA: Off

11 OK: On

11 NG: Off

11 NA: Off

12 OK: On

12 NG: Off

12 NA: Off

38 OK: Off

38 NG: Off

38 NA: On

40 OK: On

40 NG: Off

40 NA: Off

41 OK: On

41 NG: Off

41 NA: Off

42 NG: Off

42 NA: On

42 OK: Off

1 OK: On

1 NG: Off

1 NA: Off

2 OK: On

2 NG: Off

2 NA: Off

3 NA: Off

3 OK: On

3 NG: Off

4 OK: On

4 NG: Off

4 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

29 OK: On

29 NG: Off

29 NA: Off

28 OK: On

28 NG: Off

28 NA: Off

27 OK: On

27 NG: Off

27NA: Off

26 OK: On

26 NG: Off

26 NA: Off

25 OK: On

25 NG: Off

25 NA: Off

24 OK: Off

24 NG: Off

24 NA: On

13 NA: Off

14 NG: Off

14 NA: Off

13 OK: On

13 NG: Off

14 OK: On

23 OK: Off

23 NG: Off

23 NA: On

22 OK: On

22 NG: Off

22 NA: Off

21 OK: Off

21 NG: Off

21 NA: On

20 OK: Off

20 NG: Off

20 NA: On

19 OK: On

19 NG: Off

19 NA: Off

18 OK: On

18 NG: Off

18 NA: Off

17 OK: On

17 NG: Off

17 NA: Off

16 OK: On

16 NG: Off

16 NA: Off

15 OK: On

15 NG: Off

15 NA: Off

1 OK: On

1 NG: Off

1 NA: Off

2 OK: On

2 NG: Off

2 NA: Off

3 OK: On

3 NG: Off

3 NA: Off

4 OK: On

4 NG: Off

4 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

8 OK: On

8 NG: Off

8 NA: Off

9 OK: On

9 NG: Off

9 NA: Off

10 OK: On

10 NG: Off

10 NA: Off

11 OK: Off

11 NG: Off

11 NA: On

12 OK: On

12 NG: Off

12 NA: Off

13 OK: On

13 NG: Off

13 NA: Off

14 OK: On

14 NG: Off

14 NA: Off

15 OK: On

15 NG: Off

15 NA: Off

16 OK: On

16 NG: Off

16 NA: Off

17 OK: Off

17 NG: Off

17 NA: On

18 OK: On

18 NG: Off

18 NA: Off

19 OK: On

19 NG: Off

19 NA: Off

20 OK: Off

20 NG: Off

20 NA: On

Sig:

Comments: Elevator passed inspection.

Date_af_date: 4/16/24

(a) See ASME A17.2 for detailed Code requirements. Numbering is tied to the numbering on A17.2 sections.

(b) OK = Meets requirements NG = Insert number to identify comment on back of this checklist NA = Not Applicable

Address: _______________________________________________________________________________________________________________________________________________________

ID No.: ___________________________________________________________________________ Code Edition: ________________________________________________________________

Passenger Rated Load: _________________________ lb or kg Inspected by: ______________________________________________________________

Freight Class: __________________________________________ Signature: ____________________________________________________________________

Speed: ________________________ fpm or m/s Certifi cate No: _______________ Certifying Organization: ___________________________________________________

1.3 Operating control devices

1.4 Sills and car fl oor

1.5 Car lighting and receptacles

1.6 Car emergency signal

1.7 Car door or gate

1.8 Door closing force

1.9 Power closing of doors or gates

1.10 Power opening of doors or gates

1.11 Car vision panels and glass car doors

1.12 Car enclosure

1.13 Emergency exit

1.14 Ventilation

1.15 Signs and operating device symbols

1.16 Rated load, platform area and data plate

1.17 Standby power operation

1.18 Restricted opening of car or hoistway doors

1.19 Car ride

2.3 Lighting and receptacles

2.4 Machine space

2.5 Housekeeping

2.10 Numbering of elevators, machines, controllers and disconnect switches

2.11 Disconnecting means and control

2.12 Controller wiring, fuses, grounding, etc.

2.13 Governor, overspeed switch and seal

2.14 Code data plate

2.15 Static control

2.16 Overhead beam and fastenings

2.17 Drive machine brake

2.18 Traction drive machines

2.19 Gears, bearings and fl exible couplings

2.20 Winding drum machine and slack cable rope

device, stop motion switch and rope fastening

2.21 Belt or chain drive machine

2.22 Motor generator

2.23 Absorption of regenerated power

2.24 AC drives from a DC source

2.25 Traction sheaves

2.26 Secondary and defl ector sheaves

2.27 Rope fastenings

2.28 Terminal stopping devices

2.29 Car and counterweight safeties

2.38 Roped water hydraulic elevators

2.40 MCP and Maintenance Records

2.41 Static Control

3.3 Top of car operating device

3.4 Top of car clearance, refuge space

and standard railing

3.5 Normal terminal stopping device

3.6 Final and emergency terminal stopping devices

3.7 Car leveling and anticreep devices

3.8 Top emergency exit

3.9 Floor and emergency identifi cation numbering

3.10 Hoistway construction

3.11 Hoistway smoke control

3.12 Pipes, wiring and ducts

3.13 Windows, projections, recesses and setbacks

3.14 Hoistway clearances

3.15 Multiple hoistways

3.16 Traveling cables and junction boxes

3.17 Door and gate equipment

3.18 Car frame and stiles

3.19 Guide rails, fastenings and equipment

3.20 Governor rope

3.21 Governor releasing carrier

3.22 Wire rope fastening and hitch plate

3.23 Suspension means

3.27 Crosshead data plate and rope data tags

3.28 Counterweight and counterweight buffer

3.29 Counterweight safeties

3.30 Speed test

3.33 Compensating ropes and chains

4.3 Vision panels

4.4 Hoistway door locking devices

4.5 Access to hoistway

4.6 Power closing of hoistway doors

4.7 Sequence operation

4.8 Hoistway enclosure

4.9 Elevator parking device

refuge space

5.3 Final and emergency terminal stopping device

5.4 Normal terminal stopping devices

5.5 Traveling cables

5.6 Governor rope tension device

5.12 Car buffer

5.13 Guiding members (rails, rollers, slides)

6.3 A17.1-1984 through A17.1a-1988 and A17.3

6.4 A17.1b-1989 through A17.1b-2000

6.5 A17.1-2000 and B44-00

6.6 A17.1-2004 and B44-04

6.7 A17.1-2007 and B44-07

Address: Wilkes-Barre VAMC 1111 East End Blvd. Wilkes-Barre, PA 18711

ID No: P5 Green Elevator

Rated Load: 4000 lbs

Routine: Off

Periodic: On

Acceptance: Off

Inspected By: George Boone

Certifying Organization: NAESA

Code Edition: 2000

Certificate No: C-6615

Speed: 300 fpm

Class:

Passenger: On

Freight: Off

1 OK: On

1 NG: Off

1 NA: Off

12 OK: Off

12 NG: Off

12 NA: On

10 OK: Off

10 NG: Off

10 NA: On

9 OK: On

9 NG: Off

9 NA: Off

8 OK: On

8 NG: Off

8 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

4 OK: On

4 NG: Off

4 NA: Off

3 OK: Off

3 NG: Off

3 NA: On

2 OK: On

2 NG: Off

2 NA: Off

1 OK: Off

1 NG: Off

1 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

10 OK: Off

10 NG: Off

10 NA: On

11 OK: Off

11 NG: Off

11 NA: On

12 OK: Off

12 NG: Off

12 NA: On

13 OK: Off

13 NG: Off

13 NA: On

14 NG: Off

14 NA: On

14 OK: Off

15 OK: Off

15 NG: Off

15 NA: On

16 OK: Off

16 NG: Off

16 NA: On

17 OK: Off

17 NG: Off

17 NA: On

18 OK: Off

18 NG: Off

18 NA: On

19 OK: Off

19 NG: Off

19 NA: On

20 NG: Off

20 OK: Off

21 OK: Off

21 NG: Off

21 NA: On

22 OK: Off

22 NG: Off

22 NA: On

23 OK: Off

23 NG: Off

23 NA: On

27 OK: Off

27 NG: Off

27 NA: On

28 OK: Off

28 NG: Off

28 NA: On

29 OK: Off

29 NG: Off

20 NA: On

29 NA: On

30 OK: Off

30 NG: Off

30 NA: On

34 OK: Off

34 NG: Off

34 NA: On

33 OK: Off

33 NG: Off

33 NA: On

1 OK: Off

1 NG: Off

1 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

1 OK: Off

1 NG: Off

1 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

12 OK: Off

12 NG: Off

12 NA: On

13 OK: Off

13 NG: Off

13 NA: On

16 OK: Off

16 NG: Off

16 NA: On

10 OK: Off

10 NG: Off

10 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

8 OK: On

8 NG: Off

8 NA: Off

9 OK: On

9 NG: Off

9 NA: Off

10 OK: On

10 NG: Off

10 NA: Off

11 OK: On

11 NG: Off

11 NA: Off

12 OK: On

12 NG: Off

12 NA: Off

38 OK: Off

38 NG: Off

38 NA: On

40 OK: On

40 NG: Off

40 NA: Off

41 OK: On

41 NG: Off

41 NA: Off

42 NG: Off

42 NA: On

42 OK: Off

1 OK: On

1 NG: Off

1 NA: Off

2 OK: On

2 NG: Off

2 NA: Off

3 NA: Off

3 OK: On

3 NG: Off

4 OK: On

4 NG: Off

4 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

29 OK: On

29 NG: Off

29 NA: Off

28 OK: On

28 NG: Off

28 NA: Off

27 OK: On

27 NG: Off

27NA: Off

26 OK: On

26 NG: Off

26 NA: Off

25 OK: On

25 NG: Off

25 NA: Off

24 OK: Off

24 NG: Off

24 NA: On

13 NA: Off

14 NG: Off

14 NA: Off

13 OK: On

13 NG: Off

14 OK: On

23 OK: Off

23 NG: Off

23 NA: On

22 OK: On

22 NG: Off

22 NA: Off

21 OK: Off

21 NG: Off

21 NA: On

20 OK: Off

20 NG: Off

20 NA: On

19 OK: On

19 NG: Off

19 NA: Off

18 OK: On

18 NG: Off

18 NA: Off

17 OK: On

17 NG: Off

17 NA: Off

16 OK: On

16 NG: Off

16 NA: Off

15 OK: On

15 NG: Off

15 NA: Off

1 OK: On

1 NG: Off

1 NA: Off

2 OK: On

2 NG: Off

2 NA: Off

3 OK: On

3 NG: Off

3 NA: Off

4 OK: On

4 NG: Off

4 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

8 OK: On

8 NG: Off

8 NA: Off

9 OK: On

9 NG: Off

9 NA: Off

10 OK: On

10 NG: Off

10 NA: Off

11 OK: Off

11 NG: Off

11 NA: On

12 OK: On

12 NG: Off

12 NA: Off

13 OK: On

13 NG: Off

13 NA: Off

14 OK: On

14 NG: Off

14 NA: Off

15 OK: On

15 NG: Off

15 NA: Off

16 OK: On

16 NG: Off

16 NA: Off

17 OK: Off

17 NG: Off

17 NA: On

18 OK: Off

18 NG: On

18 NA: Off

19 OK: On

19 NG: Off

19 NA: Off

20 OK: Off

20 NG: Off

20 NA: On

Sig:

Comments: Provide to repair/replace door restrictor.

Date_af_date: 4/16/24

(a) See ASME A17.2 for detailed Code requirements. Numbering is tied to the numbering on A17.2 sections.

(b) OK = Meets requirements NG = Insert number to identify comment on back of this checklist NA = Not Applicable

Address: _______________________________________________________________________________________________________________________________________________________

ID No.: ___________________________________________________________________________ Code Edition: ________________________________________________________________

Passenger Rated Load: _________________________ lb or kg Inspected by: ______________________________________________________________

Freight Class: __________________________________________ Signature: ____________________________________________________________________

Speed: ________________________ fpm or m/s Certifi cate No: _______________ Certifying Organization: ___________________________________________________

1.3 Operating control devices

1.4 Sills and car fl oor

1.5 Car lighting and receptacles

1.6 Car emergency signal

1.7 Car door or gate

1.8 Door closing force

1.9 Power closing of doors or gates

1.10 Power opening of doors or gates

1.11 Car vision panels and glass car doors

1.12 Car enclosure

1.13 Emergency exit

1.14 Ventilation

1.15 Signs and operating device symbols

1.16 Rated load, platform area and data plate

1.17 Standby power operation

1.18 Restricted opening of car or hoistway doors

1.19 Car ride

2.3 Lighting and receptacles

2.4 Machine space

2.5 Housekeeping

2.10 Numbering of elevators, machines, controllers and disconnect switches

2.11 Disconnecting means and control

2.12 Controller wiring, fuses, grounding, etc.

2.13 Governor, overspeed switch and seal

2.14 Code data plate

2.15 Static control

2.16 Overhead beam and fastenings

2.17 Drive machine brake

2.18 Traction drive machines

2.19 Gears, bearings and fl exible couplings

2.20 Winding drum machine and slack cable rope

device, stop motion switch and rope fastening

2.21 Belt or chain drive machine

2.22 Motor generator

2.23 Absorption of regenerated power

2.24 AC drives from a DC source

2.25 Traction sheaves

2.26 Secondary and defl ector sheaves

2.27 Rope fastenings

2.28 Terminal stopping devices

2.29 Car and counterweight safeties

2.38 Roped water hydraulic elevators

2.40 MCP and Maintenance Records

2.41 Static Control

3.3 Top of car operating device

3.4 Top of car clearance, refuge space

and standard railing

3.5 Normal terminal stopping device

3.6 Final and emergency terminal stopping devices

3.7 Car leveling and anticreep devices

3.8 Top emergency exit

3.9 Floor and emergency identifi cation numbering

3.10 Hoistway construction

3.11 Hoistway smoke control

3.12 Pipes, wiring and ducts

3.13 Windows, projections, recesses and setbacks

3.14 Hoistway clearances

3.15 Multiple hoistways

3.16 Traveling cables and junction boxes

3.17 Door and gate equipment

3.18 Car frame and stiles

3.19 Guide rails, fastenings and equipment

3.20 Governor rope

3.21 Governor releasing carrier

3.22 Wire rope fastening and hitch plate

3.23 Suspension means

3.27 Crosshead data plate and rope data tags

3.28 Counterweight and counterweight buffer

3.29 Counterweight safeties

3.30 Speed test

3.33 Compensating ropes and chains

4.3 Vision panels

4.4 Hoistway door locking devices

4.5 Access to hoistway

4.6 Power closing of hoistway doors

4.7 Sequence operation

4.8 Hoistway enclosure

4.9 Elevator parking device

refuge space

5.3 Final and emergency terminal stopping device

5.4 Normal terminal stopping devices

5.5 Traveling cables

5.6 Governor rope tension device

5.12 Car buffer

5.13 Guiding members (rails, rollers, slides)

6.3 A17.1-1984 through A17.1a-1988 and A17.3

6.4 A17.1b-1989 through A17.1b-2000

6.5 A17.1-2000 and B44-00

6.6 A17.1-2004 and B44-04

6.7 A17.1-2007 and B44-07

Address: Wilkes-Barre VAMC 1111 East End Blvd. Wilkes-Barre, PA 18711

ID No: P6 Green Elevator

Rated Load: 4000 lbs

Routine: Off

Periodic: On

Acceptance: Off

Inspected By: George Boone

Certifying Organization: NAESA

Code Edition: 2000

Certificate No: C-6615

Speed: 300 fpm

Class:

Passenger: On

Freight: Off

1 OK: On

1 NG: Off

1 NA: Off

12 OK: Off

12 NG: Off

12 NA: On

10 OK: Off

10 NG: Off

10 NA: On

9 OK: On

9 NG: Off

9 NA: Off

8 OK: On

8 NG: Off

8 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

4 OK: On

4 NG: Off

4 NA: Off

3 OK: Off

3 NG: Off

3 NA: On

2 OK: On

2 NG: Off

2 NA: Off

1 OK: Off

1 NG: Off

1 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

10 OK: Off

10 NG: Off

10 NA: On

11 OK: Off

11 NG: Off

11 NA: On

12 OK: Off

12 NG: Off

12 NA: On

13 OK: Off

13 NG: Off

13 NA: On

14 NG: Off

14 NA: On

14 OK: Off

15 OK: Off

15 NG: Off

15 NA: On

16 OK: Off

16 NG: Off

16 NA: On

17 OK: Off

17 NG: Off

17 NA: On

18 OK: Off

18 NG: Off

18 NA: On

19 OK: Off

19 NG: Off

19 NA: On

20 NG: Off

20 OK: Off

21 OK: Off

21 NG: Off

21 NA: On

22 OK: Off

22 NG: Off

22 NA: On

23 OK: Off

23 NG: Off

23 NA: On

27 OK: Off

27 NG: Off

27 NA: On

28 OK: Off

28 NG: Off

28 NA: On

29 OK: Off

29 NG: Off

20 NA: On

29 NA: On

30 OK: Off

30 NG: Off

30 NA: On

34 OK: Off

34 NG: Off

34 NA: On

33 OK: Off

33 NG: Off

33 NA: On

1 OK: Off

1 NG: Off

1 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

1 OK: Off

1 NG: Off

1 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

12 OK: Off

12 NG: Off

12 NA: On

13 OK: Off

13 NG: Off

13 NA: On

16 OK: Off

16 NG: Off

16 NA: On

10 OK: Off

10 NG: Off

10 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

8 OK: On

8 NG: Off

8 NA: Off

9 OK: On

9 NG: Off

9 NA: Off

10 OK: On

10 NG: Off

10 NA: Off

11 OK: On

11 NG: Off

11 NA: Off

12 OK: On

12 NG: Off

12 NA: Off

38 OK: Off

38 NG: Off

38 NA: On

40 OK: On

40 NG: Off

40 NA: Off

41 OK: On

41 NG: Off

41 NA: Off

42 NG: Off

42 NA: On

42 OK: Off

1 OK: On

1 NG: Off

1 NA: Off

2 OK: On

2 NG: Off

2 NA: Off

3 NA: Off

3 OK: On

3 NG: Off

4 OK: On

4 NG: Off

4 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

29 OK: On

29 NG: Off

29 NA: Off

28 OK: On

28 NG: Off

28 NA: Off

27 OK: On

27 NG: Off

27NA: Off

26 OK: On

26 NG: Off

26 NA: Off

25 OK: On

25 NG: Off

25 NA: Off

24 OK: Off

24 NG: Off

24 NA: On

13 NA: Off

14 NG: Off

14 NA: Off

13 OK: On

13 NG: Off

14 OK: On

23 OK: Off

23 NG: Off

23 NA: On

22 OK: On

22 NG: Off

22 NA: Off

21 OK: Off

21 NG: Off

21 NA: On

20 OK: Off

20 NG: Off

20 NA: On

19 OK: On

19 NG: Off

19 NA: Off

18 OK: On

18 NG: Off

18 NA: Off

17 OK: On

17 NG: Off

17 NA: Off

16 OK: On

16 NG: Off

16 NA: Off

15 OK: On

15 NG: Off

15 NA: Off

1 OK: On

1 NG: Off

1 NA: Off

2 OK: On

2 NG: Off

2 NA: Off

3 OK: On

3 NG: Off

3 NA: Off

4 OK: On

4 NG: Off

4 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

8 OK: On

8 NG: Off

8 NA: Off

9 OK: On

9 NG: Off

9 NA: Off

10 OK: On

10 NG: Off

10 NA: Off

11 OK: On

11 NG: Off

11 NA: Off

12 OK: On

12 NG: Off

12 NA: Off

13 OK: On

13 NG: Off

13 NA: Off

14 OK: On

14 NG: Off

14 NA: Off

15 OK: On

15 NG: Off

15 NA: Off

16 OK: On

16 NG: Off

16 NA: Off

17 OK: Off

17 NG: Off

17 NA: On

18 OK: Off

18 NG: On

18 NA: Off

19 OK: On

19 NG: Off

19 NA: Off

20 OK: Off

20 NG: Off

20 NA: On

Sig:

Comments: Provide to repair/replace door restrictor.

Date_af_date: 4/16/24

(a) See ASME A17.2 for detailed Code requirements. Numbering is tied to the numbering on A17.2 sections.

(b) OK = Meets requirements NG = Insert number to identify comment on back of this checklist NA = Not Applicable

Address: _______________________________________________________________________________________________________________________________________________________

ID No.: ___________________________________________________________________________ Code Edition: ________________________________________________________________

Passenger Rated Load: _________________________ lb or kg Inspected by: ______________________________________________________________

Freight Class: __________________________________________ Signature: ____________________________________________________________________

Speed: ________________________ fpm or m/s Certifi cate No: _______________ Certifying Organization: ___________________________________________________

1.3 Operating control devices

1.4 Sills and car fl oor

1.5 Car lighting and receptacles

1.6 Car emergency signal

1.7 Car door or gate

1.8 Door closing force

1.9 Power closing of doors or gates

1.10 Power opening of doors or gates

1.11 Car vision panels and glass car doors

1.12 Car enclosure

1.13 Emergency exit

1.14 Ventilation

1.15 Signs and operating device symbols

1.16 Rated load, platform area and data plate

1.17 Standby power operation

1.18 Restricted opening of car or hoistway doors

1.19 Car ride

2.3 Lighting and receptacles

2.4 Machine space

2.5 Housekeeping

2.10 Numbering of elevators, machines, controllers and disconnect switches

2.11 Disconnecting means and control

2.12 Controller wiring, fuses, grounding, etc.

2.13 Governor, overspeed switch and seal

2.14 Code data plate

2.15 Static control

2.16 Overhead beam and fastenings

2.17 Drive machine brake

2.18 Traction drive machines

2.19 Gears, bearings and fl exible couplings

2.20 Winding drum machine and slack cable rope

device, stop motion switch and rope fastening

2.21 Belt or chain drive machine

2.22 Motor generator

2.23 Absorption of regenerated power

2.24 AC drives from a DC source

2.25 Traction sheaves

2.26 Secondary and defl ector sheaves

2.27 Rope fastenings

2.28 Terminal stopping devices

2.29 Car and counterweight safeties

2.38 Roped water hydraulic elevators

2.40 MCP and Maintenance Records

2.41 Static Control

3.3 Top of car operating device

3.4 Top of car clearance, refuge space

and standard railing

3.5 Normal terminal stopping device

3.6 Final and emergency terminal stopping devices

3.7 Car leveling and anticreep devices

3.8 Top emergency exit

3.9 Floor and emergency identifi cation numbering

3.10 Hoistway construction

3.11 Hoistway smoke control

3.12 Pipes, wiring and ducts

3.13 Windows, projections, recesses and setbacks

3.14 Hoistway clearances

3.15 Multiple hoistways

3.16 Traveling cables and junction boxes

3.17 Door and gate equipment

3.18 Car frame and stiles

3.19 Guide rails, fastenings and equipment

3.20 Governor rope

3.21 Governor releasing carrier

3.22 Wire rope fastening and hitch plate

3.23 Suspension means

3.27 Crosshead data plate and rope data tags

3.28 Counterweight and counterweight buffer

3.29 Counterweight safeties

3.30 Speed test

3.33 Compensating ropes and chains

4.3 Vision panels

4.4 Hoistway door locking devices

4.5 Access to hoistway

4.6 Power closing of hoistway doors

4.7 Sequence operation

4.8 Hoistway enclosure

4.9 Elevator parking device

refuge space

5.3 Final and emergency terminal stopping device

5.4 Normal terminal stopping devices

5.5 Traveling cables

5.6 Governor rope tension device

5.12 Car buffer

5.13 Guiding members (rails, rollers, slides)

6.3 A17.1-1984 through A17.1a-1988 and A17.3

6.4 A17.1b-1989 through A17.1b-2000

6.5 A17.1-2000 and B44-00

6.6 A17.1-2004 and B44-04

6.7 A17.1-2007 and B44-07

Address: Wilkes-Barre VAMC 1111 East End Blvd. Wilkes-Barre, PA 18711

ID No: S7 Service Elevator

Rated Load: 5000 lbs

Routine: Off

Periodic: On

Acceptance: Off

Inspected By: George Boone

Certifying Organization: NAESA

Code Edition: 2010

Certificate No: C-6615

Speed: 500 fpm

Class:

Passenger: Off

Freight: On

1 OK: On

1 NG: Off

1 NA: Off

12 OK: Off

12 NG: Off

12 NA: On

10 OK: Off

10 NG: Off

10 NA: On

9 OK: On

9 NG: Off

9 NA: Off

8 OK: On

8 NG: Off

8 NA: Off

7 OK: On

7 NG: Off

7 NA: Off

6 OK: On

6 NG: Off

6 NA: Off

5 OK: On

5 NG: Off

5 NA: Off

4 OK: On

4 NG: Off

4 NA: Off

3 OK: Off

3 NG: Off

3 NA: On

2 OK: On

2 NG: Off

2 NA: Off

1 OK: Off

1 NG: Off

1 NA: On

2 OK: Off

2 NG: Off

2 NA: On

3 OK: Off

3 NG: Off

3 NA: On

4 OK: Off

4 NG: Off

4 NA: On

5 OK: Off

5 NG: Off

5 NA: On

6 OK: Off

6 NG: Off

6 NA: On

7 OK: Off

7 NG: Off

7 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

8 OK: Off

8 NG: Off

8 NA: On

9 OK: Off

9 NG: Off

9 NA: On

10 OK: Off

10 NG: Off

10 NA: On

11 OK: Off

11 NG: Off

11 NA: On

12 OK: Off

12 NG: Off

12 NA: On

13 OK: Off

13 NG: Off

13…

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