Attachment 1 - Inspection Forms.pdf

REPORT OF TEST OF ELEVATOR GOVERNOR AND

SAFETY DEVICE

DATE OF TEST

TO

Government Printing Office 732 N Capitol St NW & 735 N Capitol St NE Washington, D.C. 20401/20002

NAME AND LOCATION OF STATION

TEST (Check)

[ ] ANNUAL

[ ] FIVE YEARS (See contract specifications) [ ] THREE YEARS (HYDRAULIC) (See contract specifications)

BUILDING NAME AND NO.

ELEVATOR NUMBER AND TYPE

RATED CAPACITY

LBS: PERSONS:

MAUFACTURER SERIAL NO. AND YEAR INSTALLED

RATED SPEED (FPM)

ACTUAL SPEED (FPM-TACH.)

SAFETY (See rule 205.5 code A17/1-1971 and below) OTHER

[ ] TYPE A [ ] TYPE B [ ] TYPE C [ ] BROKEN ROPE [ ] (SPECIFY)

IS SAFETY VALVE PROPERLY SET?

[ ] YES [ ] NO

DISTANCE CAR SLIDES AFTER

SAFETY IS APPLIED TO RAIL

FT IN.

MARK ON RAIL

LEFT RIGHT

[ ] RAIL [ ] RAIL FT IN

DISTANCE GOVERNOR ROPE

SLIDES THROUGH JAWS.

FT IN

CONDITION OF GOVERNOR JAWS

[ ] GOOD [ ] FAIR [ ] POOR

ROPE FROM DRUM IN TEST

FT IN

NO. OF TURNS REMAINING ON

DRUM

WAS PLATFORM OUT OF LEVEL

AFTER TEST?

[ ] YES [ ] NO (If “Yes,” how much)

WAS CAR FRAME SPRUNG AFTER

TEST? (If “Yes,” specify whether left or right)

[ ] YES [ ]NO

DAMAGE RESULTING FROM TEST

DID DAMAGE OCCUR TO THE FOLLOWING?

CAR GUIDES ROPES RAILS CLAMPS BRACKETS SAFETY

[ ] YES [ ] NO [ ] YES [ ] NO [ ] YES [ ] NO [ ] YES [ ] NO [ ] YES [ ] NO [ ] YES [ ] NO

ANY LOSS OF BUFFER OIL IN TYPE C SAFETIES?

[ ] YES [ ] NO

WAS RELEASING CARRIER PROPERLY ADJUSTED?

[ ]YES [ ] NO

ARE GUIDES FIRMLY SECURED TO CAR

FRAMES?

[ ] YES [ ] NO

DID SAFETY PARTS ON CAR FRAME SHOW FOREIGN OBSTRUCTION? NO

[ ] RUST [ ] LACK OF ATTENTION

[ ] CORROSION [ ] DAMPNESS [ ] OTHER (other please specify)

GOVERNOR

ALL PARTS FREE FROM—

PAINT? RUST? CORROSION?

[ ] YES [ ] NO [ ] YES [ ] NO [ ] YES [ ] NO

WAS GOVERNOR PROPERLY LUBRICATED?

[ ] YES [ ] NO

WAS THERE AMPLE FLY WEIGHT SPACE BETWEEN WALL AND

GOVERNOR? [ ] YES [ ] NO

WERE THERE ANY SEALS ON THE GOVERONR?

[ ] YES [ ] NO

WERE SPRING NUT LOCKS OR KEYS PROPERLY SECURED AND

SEALED? [ ] YES [ ] NO

DID GOVERNOR JAWS DROP OF OWN WEIGHT WHEN LATCH WAS

RELEASED? [ ] YES [ ] NO

DO BEARING OR GEARS SHOW EXCESSIVE WEAR?

[ ] YES [ ] NO

WAS TENSION IDLER FREE IN FRAME GUIDES AND IN ITS SHAFT?

[ ] YES [ ] NO

IS PROPER SIZE GOVERNOR ROPE BEING USED?

[ ] YES [ ] NO

IS THE PROPER TYPE OF ROPE USED?

[ ] YES [ ] NO

REMARKS

NOTE: SAFETIES SHALL BE SUBJECT TO AN ANNUAL RUNNING TES WITH NO LOAD IN THE CAR AS FOLLOWS:

APPLICABLE RULE OF ANSI.—CODE

TEST OF SAFETIES A17.1 1971

1. TUPE A, B, OR C GOVERNOR – OPERATED SAFETIES. 1001.4a1

2. WOOD GUIDE GOVERNOR – OPERATED SAFETIES 1001.4a1

3. TYPE A AND WOOD GUIDE SAFETIES WITHOUT GOVERNORS OPERATED ONLY AS A RRESULT OF THE BREAKING OR SLACKENING OF THE HOISTING ROPES 1001.4a3

CONTRACT NO.

NAME OF CONTRACTING 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 SIGNATURE OF DIRECTOR

Use reverse for any Remarks and/or recommendations

REPORT OF INSPECTION OF ELEVATORS

DATE OF INSPECTION

TO

Government Printing Office

732 N Capitol St NW & 735 N Capitol St

NE

Washington, D.C. 20401/20002

Name and Location of Station

Building Name and Number

No. of stops

No. of Openings

Elevator number and type

Rated Capacity

LBS: PERSONS

Manufacturer Serial No. and year installed

Rated Speed (fpm)

Actual Speed (fpm-tach)

1. CONDITION OF EQUIPMENT (Check)

ITEM GOOD FAIR POOR ITEM GOOD FAIR POOR

MACHINE

ELECTRONIC TUBES & TRANSISTORS

WORM AND GEAR

RESISTANCES

WORM AND GEAR THRUST BEARING

RECTIFIERS

SHEAVE SHAFT BEARINGS

CONTACT INSULATORS

WORM SHAFT PACKING AND SEALS

CONTACT HOLDERS

BEDPLATE

CONTACT SPRINGS

MAIN MOTOR

BRAIDED & WIRE CONNECTORS

MOTOR FIELDS, BRUSHES & HOLDERS

MACHINE ROOM VENTILATION

COMMUTATOR AND 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, DRUM

MAIN LINE SWITCH LOCATION

GOVERNOR AND RELEASING CARRIER

CONDITION OF MACHING ROOM FLOOR

SELECTOR, CABLE, SWITCH AND TAPE

GUARDING OF EXPOSED EQUIPMENT

CONTROLLER

PROJECTIONS, RECESSES

RELAY PANELS

HOISTWAY VENTING

RELAYS AND CONTACTS

PITT LADDER

OVERLOADS

GROUNDING OF EQUIPMENT

FUSES AND FUSE LINKS

ELECTRICAL PROTECTIVE DEVICES

MAGNET COILS

CYLINDER AND PLUNGER

CAPACITORS

PUMPS, VALVES, PIPING AND TANKS

1. CONDITION OF EQUIPMENT (CONTINUED)

ITEM GOOD FAIR POOR ITEM GOOD FAIR POOR

CROSSHEAD, SHOES, CARTOP

CAR ENCLOSURE

CAR DOORS, OPERATOR

CAR OPERATING PANEL

GUIDE RAILS AND SUPPORTS

CAR CANOPY

OVERHEAD BEAMS

CAR EMERGENCY EXIT CONTACTS

SHEAVES AND BEARINGS

CAR FLOORING

HANGERS AND DOOR GIBS

CAR LIGHTING

INTERLOCKS AND CLOSERS

CAR VENTILATIONS

LEVELING SWITCHES AND VANES

CAR CAPACTIY PLATE

TOP CAR OPERATING DEVICE

CAR TELEPHONE BOX

TRAVELING CABLE

CAR CERTIFICATE FRAME

LIMIT SWITCHES

HOISTWAY DOOR PANELS AND FRAMES

CWT, TIE RODS, AND COTTER PINS

HANGER COVERS

BUFFERS (CAR AND CWT)

FASCIA PLATES

GUARD FOR CONTERWIGHT

TOE GUARDS

GOVERNOR TENSION SHEAVE & GAURD

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

2. CONDITION OF ROPES

LOCATION MATERIALS NUMBER SIZE AND

CONSRUCTION

USED LIFE

(in months)

EST. ADD. LIFE

(in months)

NO. OF BROKEN WIRES (Per

Rope Lay)

HOISTING

DRUM COUNTERWEIGHT

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 SIGNATURE OF DIRECTOR

Use blank sheet for any remarks and/or recommendations and attach to this report.