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