36C25518Q9607-005.docx

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Attached to
VISN 15 Elevator Maintenence Inspection Services Federal contract opportunity
Solicitation number
36C25518Q9607
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 15

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36C25518Q9607 ATTACHMENT A.docx

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ATTACHMENT A

REPORT OF INSPECTION OF ELEVATORS

Date of Inspection:___________________

Name and Location of VA Station:________________________________

Elevator Number and Type: ________________________________

Manufacturer, Serial No. and Year Installed: ____________________________________

Rated Speed: _______________ ; Actual Speed: ___________________

Building Name and Number: ________________

Number of Stops:________
Number of Openings: _____________

Rated Capacity: LBS _______________; PERSONS _______________

PART 1 - CONDITION OF EQUIPMENT

ITEM
GOOD
FAIR
POOR
ITEM
GOOD
FAIR
POOR

Machine

Electronic Tubes & Transistors

Worm and Gear

Resistances

Worm Gear Thrust Bearings

Rectifiers

Sheave Shaft Bearings

Contact Insulators

Worm Shaft Packing & Seals

Contact Holders

Bedplate

Contact Springs

Main Motor

Braided & Wire Connectors

Motor Fields, Brushes & Holders

Machine Room Ventilation

Commutator & Slip Rings

Electric Wiring

Motor Generator

Lighting in Machine Room

Exciter

Heating in Machine Room

Motor Generators Field, Brushes and Holders

Clearance Around Machine Room Equipment

Brake, Pins, Lining, Main Line Switch Location

Governor & Releasing Carrier

Condition of Machine Room Floor

Selector, Cable, Switch & Tape

Guarding of Exposed Equipment

Controller

Projections, Recesses

Relay Panels

Hoistway Venting

Relays and Contacts

Pitt Ladder

Overloads

Grounding of Equipment

Fuses & Fuse Links

Electrical Protective Devices

Magnet Coils

Cylinder and Plunger

Capacitors

Pumps, Valves, Piping & Tanks

Crosshead, Shoes, Cartop

Car Enclosure

Car Doors, Operator

Car Operating Panel

Guide Rails & Supports

Car Canopy

Overhead Beams

Car Emergency Exit Contacts

Sheaves & Bearings

Car Flooring

Hangers & Door Gibs

Car Lighting

Interlock & Closers

Car Ventilation

Leveling Switches & Vanes

Car Capacity Plate

Top Car Operating Device

Car Telephone Box

Traveling Cable

Limit Switches

Hoistway Door Panels and Frames

CWT, Tie Rods and Cotter Pins

Hanger Covers

Buffers (Car & CWT)

Fascia Plates

Guard for Counterweight

Toe Guards

Governor Tension Sheave & Guard

Headers

Governor Tension Sheave Weight

Hoistway Sills

Safety

Fireproofing Under Platform

Pit Access Door

Numeral on Equipment

Car Photo-Electric Rays

Hall Lanterns

Car Doors Contacts

Hall Push Buttons

Car Safety Edge

Dispatching Panel

Faceplates at Stations

Hoistway Access Switch

Car Position Indicator

Painting of Equipment

Hall Position Indicator

Emergency Electric Power Equipment

Are Manual and Parts List Available? ______ Yes _______No

Are Tools Available? ______ Yes _______No

PART 2 – CONDITION OF ROPES

Location of Ropes
Materials
Number
Size And Construction
Used Life (in Months)
Est. Add. Life (in Months)
No. of Broken Wires (Per Rope)

Hoisting

Drum Counterweights

Car Counterweight

Governor - Car

Governor - CWT

Compensating

Safety

Contract No: ______________ Name of Contract Company___________________

Signature of Inspecting Officer _____________________________________

We certify that the contractor has complied with all requirements of the contract and specifications.

Date ________________ Signature of Engineer Officer ____________________

Use Blank Sheet for any remarks and/or recommendations and attach to this report.

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