MN State Hydraulic Elevator Test.pdf

Hydraulic Elevator Tests Minnesota Dept. of Labor and Industry Elevator Safety Section 443 Lafayette Road North St. Paul, MN 55155-4341 Phone: 651-284-5071 Email: elevator.inspections.dli@state.mn.us

City\State Id Submitted Date Elevator Contractor License #

Building Name Building Contact

Address City

TEST TYPE: ACCEPTANCE 5 YEAR (CAT5) ANNUAL (CAT1)

Frequency Description Result Mech. Initial Date A 5 1 Acceptance – 5yrs – 1yr X X No Load pressure NL X Full Load FL

X Calculated Load factors - Piston Diameter Capacity Calc. FL X X Relief Valve Pressure PR X X Cylinder and piping – Leak Test - Movement 15 Min. P F N/A X X Normal & Final terminal stopping devices: Examine and test for operation. P F N/A X X Oil Buffers P F N/A X X Firefighters’ Emergency Operation P F N/A X X Standby EP operation – annual; Battery Lowering - acceptance P F N/A X X ETSLD and ETSD test P F N/A X X Low oil protection – test for proper operation P F N/A X X SIL and EPD Devices P F N/A X X Flexible Hose and Fitting Assemblies P F N/A X X Pressure Switch P F N/A X X Door code zone speed and Door Closing force P F N/A X X Slack rope device. Test for operation. P F N/A X X Governors: operate manually – visual inspection verify parts operate freely P F N/A X X Gov. Trip Speed Gov. Pull Through force Safety Pull out force N/A X X Safeties: P F N/A X X Car Slide Counterweight Slide N/A X X Coated Rope Inspection P F N/A X X Wire Rope Fastening Inspection (Roped Hydro) P F N/A X X Plunger gripper examine and test P F N/A X X Over-speed Valve P F N/A X X Class C2 Freight Elevators *See Clarification Notes P F N/A

Common Violations 8.6.1.2.1(d) Access provided for Inspector and Mechanic for MCP and Records? Y N

8.6.1.7.2 Test tag securely attached to controller? Y N

8.9.1 Code Data Tags present and up to date Y N

8.11.3.1.1(e) Car lighting – Test back up with power off (not test button) P F N/A 8.11.3.1.1(f) Emergency Com. Phone\Alarm Bell– tested with normal power off P F N/A 8.11.3.1.1(r) Restriction of door open: = or < than 4” outside of the unlocking zone. P F N/A This form is designed to allow the user to identify when a required test was completed within the identified timeline, and the licensed individual (mechanic) performing the test. Category tests are to be completed as identified. “Other Required Documentation” shall be checked minimally once a year. Complete the form, and submit a copy annually to the Department Of Labor and Industry.

Any results identified as “Failed” shall be addressed immediately with the owner. Licensed elevator contractors shall not leave any elevator in service if an unsafe condition exists as a result of these or any other tests.

Periodic tests signed By responsible Master of Contractor License: SIGNATURE Date:

Acceptance tests Signed by Inspector SIGNATURE Date: