Attachment 3. Forms.docx

DOCX document 700 KB Posted Sep 1, 2020

Attached to: Maintenance, Repair and Testing for Elevator for Commander, Fleet Activities Chinhae and CNFK HQ Busan
Solicitation number: W91QVN20R0102
Issued by: Department of the Army Materiel Command Army Contracting Command

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File	Type	Posted
SOLICITATION AMENDMENT W91QVN20R0102-0001.docx	DOCX document	Sep 3, 2020
Attachment 1. Map for Chinhae and Busan.docx	DOCX document	Sep 1, 2020
SOLICITATION W91QVN20R0102.docx	DOCX document	Sep 1, 2020
Attachment 2. The Status of the Elevator for Buildings.docx	DOCX document	Sep 1, 2020
Attachment 4. Historical Data for Service Order Workload.docx	DOCX document	Sep 1, 2020

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Attachment 3. Forms

Form No

Spec Item No

Description

Number of Pages

7.5.1

1.6.18.2.3.

CONTRACTOR HAZARDOUS MATERIAL INVENTORY LOG

7.5.2

1.6.18.2.1.

SOLID WASTE DISPOSAL REPORT

7.5.3

5.2.1.3.

ELEVATOR PERIODIC INSPECTION CHECKLIST - ELECTRIC

7.5.4

5.2.1.3.

ELEVATOR PERIODIC INSPECTION CHECKLIST - HYDRAULIC

See Below for the FORMS

FORMS 7.5.1

CONTRACTOR HAZARDOUS MATERIAL INVENTORY LOG (EPRCA)

PRIME COMPANY NAME: CONTRACT NO:

PROJECT TITLE / LOCATION:

Material Name

Manufacturer

MSDS

Number State (i.e. Liquid, Solid, Gas) Storage Quantity

Average	Max
Daily	Daily
	Quality (lbs/gals) used in Calendar Year [	]

Contractor(s) certifies that the hazardous material(s) removed from installation will be used/reused for its intended purpose.

Company Using Material Listed Above Company Representative’s Signature

Submitted By:

Printed Name

Contracting Officer

Phone:

Fax:

Date:

or ROICC Representative Page of

CONTRACTOR HAZARDOUS MATERIAL INVENTORY LOG (EPRCA)

Continuation Sheet

PRIME COMPANY NAME: CONTRACT NO:

PROJECT TITLE / LOCATION:

Material Name

Manufacturer

MSDS

Number State (i.e. Liquid, Solid, Gas) Storage Quantity

Average	Max
Daily	Daily
	Quality (lbs/gals) used in Calendar Year [	]

Page of

FORMS 7.5.2

Solid Waste Report Construction & Demolition - Disposal & Recyclables

Provide the following information in the blanks below. Be sure to show final destination and method of disposal and recycling of all construction and demolition debris/wastes and sign at the bottom of the page. Paperwork from the disposal and/or recycling facility to be provided along with this completed form for each individual waste.

Company Name Contract Number Phone Number

Report each weight using the table below. Indicate whether the weight is in kilograms or pounds. The information is required to be segregated by landfill, incineration, or recycling. If a type of waste is not listed in the table, note the wastes along with weights and cost in the blanks of the table below. All attempts should be made to recycle as much of the wastes as possible.

Type of Waste Weight (kg or lb.)

Cost (KW, $) Location of Disposal or Recycling

Date

Disposal (Landfill or Incineration)

Recycling

Brick

Wood

Metals

Paper/Cardboard

Soil

Gravel

Plastic

Glass

Concrete

Asphalt

Roof Tile

TOTAL

In accordance with Commander, Fleet Activities Chinhae (CFAC) Environmental Management System (EMS), this form (or equivalent) documents that the individual listed above is aware of the responsibility to report accurate solid waste disposal and recycle weights to the Public Works Department, Environmental Division in a timely manner.

Signature Date

7.5.3 ELEVATOR PERIODIC INSPECTION CHECKLIST - ELECTRIC

CHECKLIST FOR INSPECTION OF ELECTRIC ELEVATORSManufacturer: Inst Yr: Code: Certifying Org:

NAVFAC Certified:

Signature:

Elevator Unit:

No Yes Certificate Issued:

Inspector:

Periodic (6-Month) Category 1 (1-Year) Category 5 (5-Year) Acceptance After Major Repair

	Stops:
Insp Date:	Expires:
	Inspection and Test

Activity: Base: Building: Elevator ID:

Passenger Rated load:

Handicap kg Machine room less Roping:

Freight class Speed: m/min

Item No.	Item No.
	1
	INSIDE OF CAR
	OK
	NG
	NA

OK NG

1.1

Door reopening device

3.4 Top-of-car clearance, refuge space, std-railing

1.2

Stop switch

3.5 Normal terminal stopping device

1.3

Operating control devices

3.6 Final and emergency terminal stopping device

1.4

Sills and car floor

3.7 Car leveling device

1.5

Car lighting and receptacles

3.8 Top emergency exit

1.6

Car emergency signal

3.9 Floor and emergency identification numbering

1.7

Car door or gate

3.10 Hoistway construction

1.8

Door closing force

3.11 Hoistway smoke control

1.9

Power closing of doors or gates

3.12 Pipes, wiring, and ducts

1.10

Power opening of doors or gates

3.13 Windows, projections, recesses and setbacks

1.11

Car vision panels and glass car doors

3.14 Hoistway clearances

1.12

Car enclosure

3.15 Multiple hoistway

1.13

Emergency exit

3.16 Traveling cables and junction boxes

1.14

Ventilation

3.17 Door and gate equipment

1.15

Signs and operating device symbols

3.18 Car frame and stiles

1.16

Rated load, platform area, and data plate

3.19 Guide rails fastening and equipment

1.17

Standby power operation

3.20 Governor rope

1.18

Restricted opening of car or hoistway doors

3.21 Governor releasing carrier

1.19

Car ride

3.22 Wire rope fastening and hitch plate

1.20

Earthquake devices

3.23 Suspension rope

3.24 Top counterweight clearance

MACHINE ROOM

3.25 Car, overhead, and deflector sheaves

2.1

Access to machine space

3.26 Broken rope, chain or tape switch

2.2

Headroom

3.27 Crosshead data plate and rope data tags

2.3

Lighting and receptacles

3.28 Counterweight and counterweight buffer

2.4

Machine space

3.29 Counterweight safeties

2.5

Housekeeping

3.33 Compensating ropes and chains

2.6

Ventilation

3.34 Earthquake devices

2.7

Fire extinguisher

2.8

Pipes, wiring, and ducts

4 OUTSIDE HOISTWAY

2.9

Guarding of exposed auxiliary equipment

4.1 Car platform guard

2.10

Numbering of elevators, machines

4.2 Hoistway doors

and disconnect switches

4.3 Vision panels

2.11

Disconnecting means/control

4.4 Hoistway door locking device

2.12

Controller wiring, fuses, grounding, etc.

4.5 Access to hoistway

2.13

Governor, overspeed SW and seal

4.6 Power closing of hoistway doors

2.14

Code data plate

4.7 Sequence operation

2.15

Static control

4.8 Hoistway enclosure

2.16

Overhead beams and fastenings

4.9 Elevator parking device

2.17

Drive machine brake

4.10 Emergency doors in blind hoistways

2.18

Traction drive machines

4.11 Separate counterweight hoistway

2.19

Gears, bearings and flexible couplings

4.12 Standby power selection switch

2.20

Winding drum machines

2.21

Belt- or chain-drive machine

5 PIT

2.22

Motor generator

5.1 Pit access, lighting and stop switch, and condition

2.23

Absorption of regenerated power

5.2 Bottom clearance, runby, refuge space

2.24

AC drives from a DC source

5.3 Final and emergency terminal stopping devices

2.25

Traction sheaves

5.4 Normal terminal stopping devices

2.26

Secondary and deflector sheaves

5.5 Traveling cables

2.27

Rope fastenings

5.6 Governor rope tension devices

2.28

Terminal stopping devices

5.7 Car frame and platform

2.29

Car and counterweight safeties

5.8 Car safeties and guiding members

2.40

Maintenance records

5.9 Buffer/ Emergency terminal speed limiting device

2.42

Earthquake devices

5.10 Compensating chains, ropes and sheaves

TOP OF CAR

5.16 Earthquake devices

3.1

Stop switch

6 FIREFIGHTERS’ SERVICE

3.2

Car top light and outlet

6.0 Firefighters’ service

3.3

Top of car operating device

See ASME A17.2 and JIS for detailed Code requirements.

OK = meets requirements; NG = insert number to identify comment on page 2; NA = not applicable.

Enclosure (2) Page 1 of 2

7.5.3 ELEVATOR PERIODIC INSPECTION CHECKLIST - ELECTRIC

CHECKLIST FOR INSPECTION OF ELECTRIC ELEVATORS

DEFICIENCY DESCRIPTION

Activity/Address: Base:

Inspection Date: Inspector:

Building:

NAVFAC Certified:

Elevator ID:
	Elevator Unit:
Certifying Organization:

Item No.

Deficiency Description

A17.1-2013

Item No.

High Risk Safety and Fire Protection Safety Concerns

A17.1-2013

Item No.

Medium Risk Safety Concerns and Building Code Requirements

A17.1-2013

Item No.

Low Risk Safety Concerns (Unlisted in Summary)

A17.1-2013

Prepared by Code PW5 (Operations Facilities Sustainment), NAVFAC FAR EAST

Enclosure (2) Page 2 of 2

7.5.3 ELEVATOR PERIODIC INSPECTION CHECKLIST - ELECTRIC

NAVFAC ELEVATOR EVALUATION & CATEGORY-1 TEST DATA SHEET ELECTRIC TRACTION ELEVATORS

Activity:

Service:
kg
Insp. Date:
/	/

Base: Building: Elev. ID:

Elevator Unit:

Type:

Year Installed: Installer:

Roping: Stops: Maint. Co.:

F ~ F

MANUFACTURER

Controller: A17.1 Edition: Machine:

MACHINE ROOM

PIT

PWS for Maintenance, Repair and Testing VTE at CFA Chinhae, South Korea 48 of 73 Enclosure (2)

UNCLASSIFIED / FOR OFFICIAL USE ONLY

No Load:

DATA UP	DATA DOWN
m/min Amp. Volts m/min Amp. Volts		Bottom Counterweight Runby:	mm

Observed Ropes Slip Traction-Down Direction:

Yes

No	Car/Counterweight
Buffer Type:	Stroke: Car:	mm CWT:	mm

Sheave Groove (JIS):

Brake Shoe Thickness (JIS):

	>	mm
>	mm
		mm
	mm
	Oil Car Buffer Test (Slow speed w/ no load)	Plunger Return Time (Car):	Oil CWT Buffer Test (Slow speed w/ no load)	Plunger Return Time (Counterweight):

HOISTWAY

Insulation to Ground:

Fire rating machine ro om door:

	Safety Test (Slow speed w/ no load)
Safety Type (A, B, C):		Safety Switch:	Yes	No

Overspeed Governor	DATA TAG
Governor Manufacturer & Model #:		Observed hoist ropes slip traction:	Governor Rope Material & Construction: STEEL	x	( )	Safety Adjustment Means Sealed:	Yes	No Rope Breaking Strength (kg):	kg

DATA TAG

TEST

Governor Rope Size:
	mm
	mm

Governor Tripping Speed:
	m/min
	m/min

Overspeed Switch Trip Speed:

m/min

Governor Calibrated & Sealed:

No Fire Retardant Door-Lock Wires Installed:

Yes No

Pull Through Sealed:

No Fire Rating of Hoistway Entrance Assemblies: Actual Rope Size: mm

Ascending Car Overspeed and Unintended Car Movement Protection Ascending: m/min Power Off: Unintended: mm Auto-Reset: TOP OF CAR

Drum Rope Pull-out: Turns Left on Drum:

Firefighter’s and Other Operation

Sprinkler: ea Smoke: ea Heat: ea

Phase I : By Key:

By Signal:

Crosshead Data Plate

Phase II : By Key:

Shunt Trip:

Rated Load:

kg Serial Number:

Earthquake Operation:

Batteries (100% Load)

Rated Speed:

m/min Rope Size:

mm Parking Key Operation:

Intercom Condition:

Car Weight:

kg # of Ropes:

ea Sprinkler:

ea Smoke:

Heat:

ea Rope Construction:

x S ( )

Name(print) & Signature:

NAVFAC Cert ified:

Rope Breaking Strength:	kg
Design Counterbalance:	%

Manufacturer:

7.5.3 ELEVATOR PERIODIC INSPECTION CHECKLIST - ELECTRIC

NAVFAC ELEVATOR EVALUATION & CATEGORY-5 TEST DATA SHEET ELECTRIC TRACTION ELEVATORS

Activity:

Service:
kg
Insp. Date:
/	/

Base: Building: Elev. ID:

Type:

Year Installed: Installer:

Roping: Stops: Maint. Co.:

F ~ F

MANUFACTURER

Controller: A17.1 Edition: Machine:

MACHINE ROOM

PIT

DATA UP

DATA DOWN

Bottom Car Runby:
	mm

m/min Amp. Volts

Bottom Counterweight Runby:
	mm

No Load:

Bottom Clearance:
	mm

Rated Load: Pit Refuge Space: x x (H) mm

Observed Ropes Slip Traction-Down Direction:

Yes

Car/Counterweight

Observed Ropes Slip Traction-Up Direction:
Yes
No
Buffer Type:	Stroke: Car:	mm CWT:	mm

Sheave Groove (JIS): > mm mm Oil Car Buffer Test (rated speed w/ rated load) Brake Shoe Thickness (JIS): > mm mm Plunger Return Time (Car): Balance Load Test Oil CWT Buffer Test (rated speed w/no load) Balanced Load: kg Test By Hand: Yes No Plunger Return Time (Counterweight): Up Amp: A Down Amp: A Counterbalance: %HOISTWAY

Brake Test (Load: Passenger 125%, Freight 100% & C2 150%)

Level: (125% / 100%)	TOP:	mm BTM:	mm	Safety Test (Rated speed w/ rated load)
Brake Hold: (125% / 100% / 150%)	(Car at Lowest Landing without Power)	Safety Type (A, B, C):
Yes	NoInsulation to Ground:

Fire rating machine room door:

Safety Switch:

Overspeed Governor

DATA TAG

Length Of Safety Shoe:

Governor Manufacturer & Model #:

Observed hoist ropes slip traction:

Governor Rope Material & Construction: STEEL

( )

Safety Adjustment Means Sealed:

Yes

No Rope Breaking Strength (kg):

Type B Safety Slide Required by Code

DATA TAG

TEST

Minimum:

Maximum:

Governor Rope Size:

Safety Slide (slide marks minus length of shoe)

Governor Tripping Speed:

m/min

Car

Counterweight

Overspeed Switch Trip Speed:

m/min

Right Side:

Pull Through Force: Min 167%RC& max1/5 rbs kg kg Left Side: mm mm

Activate Safety Force (or releasing carrier):max60% ptf kg Average: mm mm

Governor Calibrated & Sealed:

Yes

No Fire Retardant Door-Lock Wires Installed:

Yes No

Pull Through Sealed:

Yes

No	Fire Rating of Hoistway Entrance Assemblies:	Actual Rope Size:	mm
Top Counterweight Clearance:	mm > BCR + BfSt + 50 Drum Rope Pull-out:	Turns Left on Drum:TOP OF CAR

Ascending Car Overspeed and Unintended Car Movement Protection

Ascending:

m/min Power Off:

Unintended:

mm Auto-Reset:

Firefighter’s and Other Operation

Phase I : By Key:

By Signal:

Phase II : By Key:

Shunt Trip:

Earthquake Operation:

Batteries (100% Load)

Parking Key Operation:

Intercom Condition:

Sprinkler:

ea Smoke:

Heat:

Name(print) & Signature:

NAVFAC Cert ified:

Car Top & HWY Top:	mm Crosshead & HWY Top:	mm
Top of Car Refuge Space:	x	x	(H) mm Sprinkler: ea Smoke: ea Heat: ea Crosshead Data Plate
Rated Load:	kg Serial Number:		Rated Speed:	m/min Rope Size:	mm Car Weight:	kg # of Ropes:	ea Rope Construction:	x S ( )	Rope Breaking Strength:	kg
Design Counterbalance:		%

Manufacturer:

7.5.4 ELEVATOR PERIODIC INSPECTION CHECKLIST - HYDRAULIC

CHECKLIST FOR INSPECTION OF HYDRAULIC ELEVATORS

Code: Certifying Org:

Roping:

Manufacturer: Inst Yr:

Signature:

NAVFAC Certified:

No Yes Certificate Issued:

Inspector:

Insp Date: Expires:

Inspection and test Periodic (6-Month) Category 1 (1-Year) Category 3 (3-Year) Category 5 (5-Year) Acceptance Rated Load: kg Speed: m/min Elevator Unit:

Freight class A

Handicap

Stops:

Activity: Base: Building: Elevator ID:

Passenger

Item No. 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 floor

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 devices

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

2.8 Pipes, wiring, and ducts

2.9 Guarding of exposed auxiliary equipment

2.10 Numbering of elevators, machines, 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

2.30 Hydraulic power unit

2.31 Relief valves

2.32 Control valve

2.33 Tanks

2.34 Flexible hydraulic hose and fitting assemblies

2.35 Supply line and shutoff valve

2.36 Hydraulic cylinders

2.37 Pressure switch

2.38 Roped water hydraulic elevators

2.39 Low oil protection

2.40 Maintenance records

2.41 Static control

2.42 Earthquake devices

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 and refuge space

3.5 Normal terminal stopping device

See ASME A17.2 and JIS for detailed Code requirements.

Item No. OK NG NA

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 identification 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 rope

3.25 Car, overhead, and deflector sheaves

3.27 Crosshead data plate and rope data tags

3.28 Counterweight and counterweight buffer

3.29 Counterweight safeties

3.30 Speed test

3.31 Slack rope device - roped hydraulic elevators

3.32 Traveling sheave - roped hydraulic elevators

3.34 Earthquake devices

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 and stop switch, and condition

5.2 Bottom clearance, runby, minimum refuge space

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 safeties and guiding members

5.11 Plunger and cylinder

5.12 Car buffer

5.13 Guiding members

5.14 Supply piping

5.15 Overspeed valve

5.16 Earthquake devices

6 FIREFIGHTERS’ SERVICE

6.0 Firefighters’ service

OK = meets requirements; NG = insert number to identify comment on page 2; NA = not applicable.

Enclosure (2) Page 1 of 2

7.5.4 ELEVATOR PERIODIC INSPECTION CHECKLIST - HYDRAULIC

CHECKLIST FOR INSPECTION OF HYDRAULIC ELEVATORS DEFICIENCY DESCRIPTION

Activity/Address: Base:

Inspection Date: Inspector:

Building:

NAVFAC Certified:

Elevator ID:
	Elevator Unit:
Certifying Organization:

Item No.

Deficiency Description

A17.1-2013

Item No.

High Risk Safety and Fire Protection Safety Concerns

A17.1-2013

Item No.

Medium Risk Safety Concerns and Building Code Requirements

A17.1-2013

Item No.

Low Risk Safety Concerns (Unlisted in Summary)

A17.1-2013

Enclosure (2) Page 2 of 2

NAVFAC ELEVATOR INSPECTION & CATEGORY 1 TEST DATA SHEET ROPED HYDRAULIC ELEVATORS

Activity:

Service:

Insp. Date:

Base: Building: Elev. ID:

Type:

Year Installed: Installer:

Roping: Stops: Maint. Co.:

MANUFACTURER

Cylinder: Controller: Pump Unit:

Diameter:

mm Model: Model: Model:

SPEED UP SPEED DOWN Bottom Car Runby: mm

No Load:	m/min	m/min	Bottom Clearance:	mm
Pit Refuge Space:	x	x	(H) mm
Pressure Test	Bottom Plunger Clearance:Yes

Static Pressure:	Kg/cm2	Rupture Valve Set (Over speed valve):	m/min
Working Pressure:	Kg/cm2	(max. 130% Rated Speed)

Relief Pressure: Kg/cm2HOISTWAY

System Pressure Test (on Stop Ring)	OK	NG	Roped Hydraulic Safety Test Pump Unit Motor AMPS	Safety Type (A)
	Data tag:
	Amps

Volts

Safety Switch:

Yes

No Load:

Amps

Volts

Safety Test:

Working (5Y Rated Load):

Amps

Volts

Fire Retardant Door-Lock Wires Installed:

Yes

Wiring Insulation to Ground:

Fire Rating of Hoistway Entrance Assemblies:

Fire rating machine room door:

Overspeed Governor

DATA TAG

TOP OF CAR

Governor Manufacturer:

Top Runby: mm

Governor Model Number:

Top of Car Clearance: mm

Governor Rope Material:	Top of Car Refuge Space:	x	x	(H) mm
Rope Size & Construction:	mm /	x	( )

Rope Breaking Strength (rbs): kg Crosshead Data PlateGovernor Tripping Speed:

m/min m/min Rated Speed:

m/min Rope Size:

mm Overspeed Switch Trip Speed:

m/min m/min Car Weight:

kg Rope Construction:

x Governor Calibrated & Sealed:

Yes

No # of Ropes:

ea Breaking Strength:

DATA TAG TEST Rated Load: kg Serial Number:

Operating Speed Down Direction:

m/min

Manufacturer:

Install Year:

Miscellaneous Hydraulic Tests

Low Oil Timer (Oil thermo)

Pressure Switch

Manual Lowering Valve

Emergency Operation Devices

Battering Lowering

Earthquake Operation:	Batteries Operation:
15 Min Drift Test
OK

Parking Key Operation:	Intercom Condition:
Pressure Vessels
OK
NA
NG

Unexposed Portions of Pistons

Firefighter’s Operation

Phase I:	By Key:	By Signal:
NAVFAC Certified:

Phase II:	By Key:		Shunt Trip:
Sprinkler:	ea	ea	ea
	Name(print) &

Signature:

Prepared by Code PW5 (Operations Facilities Sustainment), NAVFAC FAR EAST Enclosure (2) Page 1 of 1

NAVFAC ELEVATOR INSPECTION & CATEGORY 3 TEST DATA SHEET ROPED HYDRAULIC ELEVATORS

Activity:

Service:

Insp. Date:

Base: Building: Elev. ID:

Type:

Roping: Stops: Maint. Co.:

MANUFACTURER

Cylinder: Controller: Pump Unit:

Diameter:

mm Model: Model: Model:

SPEED UP SPEED DOWN Bottom Car Run by: mm

No Load:	m/min	m/min	Bottom Clearance:	mm
Pit Refuge Space:	x	x	(H) mm
Pressure Test	Bottom Plunger Clearance:Yes

Static Pressure:	Kg/cm2	Rupture Valve Set (Over speed valve):	m/min
Working Pressure:	Kg/cm2	(max. 130% Rated Speed)

Relief Pressure: Kg/cm2HOISTWAY

System Pressure Test (on Stop Ring)	OK	NG	Roped Hydraulic Safety Test Pump Unit Motor AMPS	Safety Type (A)
	Data tag:
	Amps

Volts

Safety Switch:

Yes

No Load:

Amps

Volts

Safety Test:

Working (5Y Rated Load):

Amps

Volts

Fire Retardant Door-Lock Wires Installed:

Yes

Wiring Insulation to Ground:

Fire Rating of Hoistway Entrance Assemblies:

Fire rating machine room door:

Overspeed Governor

DATA TAG

TOP OF CAR

Governor Manufacturer:

Top Runby: mm

Governor Model Number:

Top of Car Clearance: mm

Governor Rope Material:	Top of Car Refuge Space:	x	x	(H) mm
Rope Size & Construction:	mm /	x	( )

Rope Breaking Strength (rbs): kg Crosshead Data PlateGovernor Tripping Speed:

m/min m/min Rated Speed:

m/min Rope Size:

mm Overspeed Switch Trip Speed:

m/min m/min Car Weight:

kg Rope Construction:

x Governor Calibrated & Sealed:

Yes

No # of Ropes:

DATA TAG TEST Rated Load: kg Serial Number:

Operating Speed Down Direction:

m/min

Manufacturer:

Install Year:

Miscellaneous Hydraulic Tests

Low Oil Timer (Oil thermo)

Pressure Switch

Manual Lowering Valve

Emergency Operation Devices

Battering Lowering

Earthquake Operation:	Batteries Operation:
15 Min Drift Test
OK

Parking Key Operation:	Intercom Condition:
Pressure Vessels
OK
NA
NG

Unexposed Portions of Pistons

Firefighter’s Operation

Phase I:	By Key:	By Signal:
NAVFAC Certified:

Phase II:	By Key:		Shunt Trip:
Sprinkler:	ea	ea	ea
	Name(print) &

PWS for Maintenance, Repair and Testing VTE at CFA Chinhae, South Korea 50 of 73 Enclosure (2)

UNCLASSIFIED / FOR OFFICIAL USE ONLY

7.5.4 VTE PERIODIC INSPECTION CHECKLIST - HYDRAULIC

NAVFAC ELEVATOR INSPECTION & CATEGORY 5 TEST DATA SHEET ROPED HYDRAULIC ELEVATORS

Activity:

Service:

Insp. Date:

Base: Building: Elev. ID:

Type:

Roping: Stops: Maint. Co.:

MANUFACTURER

Cylinder: Controller: Pump Unit:

Diameter:

mm Model: Model: Model:

SPEED UP SPEED DOWN Bottom Car Runby: mm

No Load:	m/min	m/min	Bottom Clearance:	mm
Rated Load (5Y):	m/min	m/min	Pit Refuge Space:	x	x	(H) mm

Pressure Test Bottom Plunger Clearance:Yes No

Static Pressure:	Kg/cm2	Rupture Valve Set (Over speed valve):	m/min
Working Pressure:	Kg/cm2	(max. 130% Rated Speed)

Relief Pressure: Kg/cm2HOISTWAY

System Pressure Test (on Stop Ring)	OK	NG	Roped Hydraulic Safety Test Pump Unit Motor AMPS	Safety Type (A)
	Data tag:
	Amps

Volts

Safety Switch:

Yes

No Load:

Amps

Volts

Safety Test:

Working (5Y Rated Load):

Amps

Volts

Fire Retardant Door-Lock Wires Installed:

Yes

Wiring Insulation to Ground:

Fire Rating of Hoistway Entrance Assemblies:

Fire rating machine room door:

Overspeed Governor

DATA TAG

TOP OF CAR

Governor Manufacturer:

Top Runby: mm

Governor Model Number:

Top of Car Clearance: mm

Governor Rope Material:	Top of Car Refuge Space:	x	x	(H) mm
Rope Size & Construction:	mm /	x	( )

Rope Breaking Strength (rbs): kg Crosshead Data PlateGovernor Tripping Speed:

m/min m/min Rated Speed:

m/min Rope Size:

mm Overspeed Switch Trip Speed:

m/min m/min Car Weight:

kg Rope Construction:

x Governor Calibrated & Sealed:

Yes

No # of Ropes:

DATA TAG TEST Rated Load: kg Serial Number:

Operating Speed Down Direction:

m/min

Manufacturer:

Install Year:

Miscellaneous Hydraulic Tests

Low Oil Timer (Oil thermo)

Pressure Switch

Manual Lowering Valve

Emergency Operation Devices

Battering Lowering

Earthquake Operation:	Batteries Operation:
15 Min Drift Test
OK

Parking Key Operation:	Intercom Condition:
Pressure Vessels
OK
NA
NG

Unexposed Portions of Pistons

Firefighter’s Operation

Phase I:	By Key:	By Signal:
NAVFAC Certified:

	Phase II:	By Key:		Shunt Trip:
Sprinkler:	ea	ea	ea
	Name(print) &

PWS for Maintenance, Repair and Testing VTE at CFA Chinhae, South Korea 51 of 73 Enclosure (2)

PWS for Maintenance, Repair and Testing VTE at CFA Chinhae, South Korea 53 of 73 image1.png image2.png

File details come from the government source that posted it. Updated Sep 1, 2020.