MN State Traction Elevator Test.pdf

Traction Elevator Test City\State Id Submitted Date Elevator Contractor License #

Building Name Building Contact

Address City

TEST TYPE ACCEPTANCE 5 YEAR (CAT 5) ANNUAL (CAT1)

Frequency Description Result Mech. Initial Date A 5 1 X X Oil Buffers P F N/A X X Safeties P F N/A X X Governors: operate manually – visual inspection verify parts operate freely P F N/A X X Slack Rope Devices on Winding Drum P F N/A X X Normal & Final terminal stopping devices: Examine and test for operation. P F N/A X X Firefighters’ Emergency Operation: P F N/A X X Standby EP operation (no load) - Verify selective operation for each car. P F N/A X X Door code zone speed\ Door Closing force P F N/A X X Broken Rope, Tape or Chain Switch operation P F N/A X X EPD and SIL rated device testing procedure performed P F N/A X X Ascending car and unintended car movement protection P F N/A X X Traction loss Detection Means P F N/A X X Broken Rope and Residual strength detection P F N/A X X Car Slide Counterweight Slide N/A X X Gov. Trip Speed Gov. Pull Through force Safety Pull out force N/A X X Oil Buffer Tests: Car- full load; Counterweight- empty car P F N/A X X Brake Tested at- 125% Capacity P F N/A X X Emergency and Standby Power P F N/A X X ETSLD and ETSD test P F N/A X X Power opening of the Door within the landing zone P F N/A X X Leveling Zone and Speed P F N/A X X Inner landing zone for static control elevators P F N/A X X Emergency Stopping Distance P F N/A X X Emergency Brake Test 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 Periodic test tag securely attached to controller? Y N

8.9.1 Code Data Tags present and up to date Y N

The following devices are the most commonly identified Non-functioning Safety devices.

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:

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