D.3 5-Year Full Load Test Inspection.pdf

VA Medical Center - Long Beach, CA

ANSI/ASME A17.1 Safety & Inspection Code for Elevators & Escalators is used as standard for testing of elevator systems.

Building Name & Number

VA Medical Center – Long Beach

Elevator Number

Acceptance Test

Five-Year Test

Test Date

Address

5901 East 7th Street

Manufacturer

Speed in fpm

City

Long Beach

State

CA

Zip

90822

Alteration Date

Capacity

Passenger duty Service duty Freight duty

FIVE (5) YEAR FULL LOAD INSPECTION & TEST

GOVERNOR

Section: 2.18

Manufacturer:

Hollister-Whitney

Governor Type: Flyball Centrifugal Other

Governor Jaw Condition: ok

Fastening Condition: ok

SAFETIES

Section: 2.17

Manufacturer:

Montgomery

Safeties Type: Type “C”

Instantaneous Flexible guide

Wedge clamp Other

Safeties Condition: ok

Car stops level Record safeties rope pull-out:

If not, record distance car is out-of-level: Record # turns on drum:

BUFFERS

Section: 2.22

CAR - Buffer Type: Spring Oil Oil level: ok

Satisfactory condition after test

CWT - Buffer Type: Spring Oil Oil level: ok

Satisfactory condition after test

Stroke measurements:

Plunger return time:

Stroke measurements:

Plunger return time: _

SAFETY

SWITCHES

Section: 2.26

In-car: ok Top-of-car: ok Pit: ok Overhead: ok

Directional Limits: up down

Final Limits: up down

SOS: Comp: Buffer

Selector cable:

Slack rope:

Other: _____________________

EMERGENCY

ITEMS

Section: 2.27

Emergency Firefighters Service Mode

Phase I recall is operating: Passed Test:

Phase II recall is operating: Passed Test:

List remarks on back:

Lobby fire sign is present: ok

DOORS

Section: 2.14

Record door closing

Force:

Safety edge and other door protective devices installed and operation:

DOB: Safety edge: Detector edge: Photocell/Lightrays:

STANDBY POWER

OPERATION

Test with no load in car: Inspected: Test passed:

MAINTENANCE

AND

PERFORMANCE

Leveling: Documentation: Door operation:

Housekeeping: Car speed: Communications:

Signals: Dispatching: Lighting:

Good Maintenance disciplines are present.

VA Medical Center - Long Beach, CA

FIVE (5) YEAR FULL LOAD ELEVATOR

INSPECTION & TEST RESULTS

GOVERNOR

Section: 2.18

Gov. tripping speed: Data tag: vs Actual:

Electrical overspeed tripping speed:

Pull through set at: Gov. is sealed? Y

Calibration needed? Y N

Gov. tripped w/full load: Y

Test tags are installed: Y

SAFETIES

Section: 2.17

Test weights added

To Cab must equal

Rated Capacity

Record length of test marks on Record Gov. rope releasing carrier

Rails caused by safeties: Pull-through setting:

Safety test tags are installed: Y

OIL

BUFFERS

Section: 2.22

CAR - Test weight added to Cab Stroke measurement:

Must equal rated capacity Oil level:

Car/CWT Condition after test: ok

CWT – Test is conducted with Stroke measurement:

NO weight in the Cab Oil level:

Buffer test tags installed:

Buffer test tags installed:

BRAKE

Rule 1002.3d

Drive machine safely lowered, stopped, and held the car at the lowest landing, with 125% of rated capacity. Yes

Comments:

Lubricate Brake Assembly

EMERGENCY

ITEMS

Section: 2.25

Test Emergency Terminal

Speed limiting devices.

ok

Static Control Elevators with speeds over 500 fpm

Test Emergency Terminal stopping devices. ok

DOORS

Section: 2.14

Power opening of doors occurs in landing zone: ok

STANDBY POWER

OPERATION

Test weight is 125% of Inspected

Rated capacity Test passed

COMMENTS/RECOMMENDATIONS