Attachment_10_-_VBM_Form_1_fillable.docx

VBM Form-1

Instructions: Print, type or use the drop down menus (where applicable) to answer the questions.

Initial Site Visit Evaluation and Inspection Circuit Number:

USMS District Number:

USMS Site Code Number:

City:

State:

Address:

Street:

Zip Code:

Barrier Manufacturer:

Barrier Type:

Crash Rated:

Crash Rating:

Evaluation: On Approach Pedestal with Card Reader?

Pedestal Proper Location?

Card Reader Activated by Loop?

Barrier Drops/Open Properly?

If safety arm gate is present, then does it work in conjunction with barrier?

Does traffic light activate from Red to Green once all barriers are down?

Does the safety loop keep barriers from activating?

Are loops in proper placement for safe and efficient operation?

Are loops in proper placement for safe and efficient operation?

Are loops in satisfactory condition?

Does traffic light turn to Red upon passing safety loop?

Is there a garage door present and set up to work in conjunction with the barrier?

Evaluation: On Departure Pedestal with Card Reader present?

Are loops in proper placement for safe and efficient operation?

Are loops in satisfactory condition?

Does loop activate card reader?

If no card reader, does the loop activate the exit barrier?

If metal is placed onto the exit loop will the barriers drop?

Is a barrier control box located in a guard booth?

If so does it have a key lock out to turn off all barrier operation?

What options are available on the control box?

Does the control box function work properly?

Does the USMS Control Room have a barrier control box?

If so does the control box have the ability to overtake control of the barriers and keep control?

Does an intercom system exist from the barrier area to the control room?

Condition of the Barrier/Gate Functions Inspection of the below items (if applicable) |_| Check and tighten all frame bolts

|_| Limit switches (adjusted if applicable)

|_| Check brakes and adjust

|_| Inspect sprockets, bearings and shafts

|_| Lubricate and adjust clutches and belt

|_| Tighten belt tension if applicable

|_| Check manual operations

|_| Check all safety devices

|_| Check for dirt, litter, sand, debris and clean

|_| Check all controls and systems to include covers, lights, buttons and any other parts receiving wear and tear

|_| Inspect all wiring in all areas, secure and wrap, if required

|_| Check all fluid levels (including hydraulic oil)

|_| Change all filters as specified by manufacturer

|_| Inspect for any leaks, build up, lines and conditions

|_| O-rings and hoses

|_| Ensure all caps are tight

|_| Check all fittings

|_| Check all filtration devices

|_| Clean all drain areas and clean

|_| Check solenoid valves, relays, pressure checks, temperature switches and oil immersion heaters, cylinder pins, properly voltage

|_| Inspect bearings, wheels, tracks

|_| Control/Circuit board inspection

|_| Inspect Barrier control box(s)

Is the Barrier safe to operate this date ?

Notes:

Technician’s Printed Name:

Technicians Signature:

JSI’s Printed Name:

JSI’s Signature:

I verify that the Barrier Contractor was present on site on the above date OSS Physical Security Specialist Printed Name:

OSS Physical Security Specialist Signature:

Date:

OSS Physical Security Specialist Comments (optional):