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
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Door reopening device
Stop switches
Operating control devices
Sills & car floor
Lighting & receptacles
Emergency signal-lighting
Closing Force
Power closing of doors or gates
Power opening of doors or gates
Emergency Exit
Motor Generator
Absorption of regenerated power
Ventilation
Additional Information
Date of Inspection
-
Month
-
Day
Year
Date
Inspector's Signature
Clear
Submit
Should be Empty: