Elevator Inspection Form
Date
-
Month
-
Day
Year
Date
Inspector Name
First Name
Last Name
Inspection Type
Periodic
Acceptance
Building Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
1
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Door reopening device
2
3
4
5
Stop switches
6
7
8
9
Operating control devices
10
11
12
13
Sills & car floor
14
15
16
17
Lighting & receptacles
18
19
20
21
Emergency signal-lighting
22
23
24
25
Closing Force
26
27
28
29
Power closing of doors or gates
30
31
32
33
Power opening of doors or gates
34
35
36
37
Emergency Exit
38
39
40
41
Motor Generator
42
43
44
45
Absorption of regenerated power
46
47
48
49
Ventilation
50
51
52
53
Additional Information
Date of Inspection
-
Month
-
Day
Year
Date
Inspector's Signature
Submit
Should be Empty: