TE_4_Inspection_Report_Form.pdf

Technical Exhibit 4 - Maintenance & Repair Inspection Report

Building No:___________ Door No:_____ OF _____ Type of Door: __________________________

Type (Check): Routine________ Emergency________

Part A - Quarterly Routine Inspection & Maintenance Date Completed/Initials

Can Be Performed In Conjuction With Emergency Repairs, Section B

Contact Bldg Personnel & Obtain Door Status/Known Problems

Verify Proper Operation Of Door Limits Switches Repair/Adjust Limit Switches/Inspect Contacts Actuating Rods Perform Visual Inspection, Operate Door In Both Directions Verifying Smooth Operation

Replace Missing/Tighten Loose Nuts, Bolts, Etc.

Visually Inspect Wiring, Buss Bars, Electrical Cable, Conduit & Mounting Hardware Inspect and Lubricate Wheel Drive Axles, Chains, Sprockets & Shafts Inspect Bumpers& Stop Blocks For Wear Lubricate Wheel Fittings, Guides, Stops & Rollers With Grease Gun Oil Levers, Links & Springs With Squirt Can Remove Debris From Door Track, Clean Drains, Remove Grates & Clean Trench Complete Parts C, D & E Below As Required

Part B - Emergency Repairs completed _____/______/__________

Notification Received From:_____________________@_____________(Date/Time)

Nature of Problem:

Remedial Action Taken (List Parts Replaced in Section C):

Part C - Parts Replaced COR Approval Required For All Parts Exceeding $50.00 In Cost (Part D)

Part Name Qty Cost (If Over $50.00)___

Part D - COR Approval Attach Copy of Written Quote for Parts Exceeding $50.00 I Hereby Approve Installation The Parts Listed Above Exceeding $50.00 In Cost

Signature/Date:_____________________________________________________

Part E - Return To Service Signature

Door Returned to To Service (Date/Time):_______________/_______________

COR Notified (Date/Time):____________________/_______________