Department of Labor and Training - Division of Occupational Safety - Elevator Unit Date: Location of Elevator:

DLT - L - 129 (11/04)

ELECTRIC ELEVATOR INSPECTION CHECK LIST

Phone Number: Last Inspected Signature:

State I.D. Number:

Passenger Freight Capacity Speed Inspected By: RI License No.: Signature of person interviewed Safety Test Information: Annual Key Code: No Deficiencies - 
INSIDE OF CAR
Door reopening device Stop switch Operating control devices Car floor and landing sill Car lighting Car emergency signal Car door or gate Door closing force Power closing of doors or gates Power opening of doors or gates Car vision panel & glass car doors Car enclosures Emergency exits Ventilation Signs & operating devices symbols, A/V
Rated load, platform area & data plate

Elevator Co

5 Year Full Load Needs Repair - NR

5 Year Governor Calibration Not Applicable - NA

INSIDE HOISTWAY (cont.)
Pipes, wiring and ducts Windows, projection & setbacks Hoistway clearances Multiple hoistway Traveling cables, junction boxes Hoistway doors & elevator gate equipment Car frame and stiles Guide rails, fastening, equipment Governor rope Governor releasing carrier Wire rope fastening & hitch plate Suspension rope Compensating ropes & chains Hoistway door locking device Access to hoistway Power closing of hoistway doors Hoistway enclosure Elevator parking device Emergency door contacts PIT Pit access, lighting & stop switch and condition Bottom clearance and run by Car and counterweight buffer Final terminal stopping device Normal terminal stopping devices Traveling cables Car frame and platform Car safeties Counterweight safeties Counterweight guard Stop switch FIREFIGHTERS SERVICE MISCELLANEOUS CHECKS Registration number stamped/marked Certificate posted

MACHINE ROOM (cont.)

Drive machine brake Drive machines Gears and bearings Winding drum machine Belt or chain drive machine Motor generator Absorption of regenerated power AC drives from DC source Traction sheave Secondary & deflector sheaves Rope fastenings Terminal stopping devices Slack cable switch Governor, overspeed switch & seal Car safeties TOP OF CAR Top of car stop switch Car top light and outlet Top of car operating device Top of car clearance & refuge space Top counterweight clearance Car overhead, deflector sheave Normal terminal stopping device Final terminal stopping device Broken rope, chain, or tape switch Car leveling device Crosshead data plate Top emergency exit INSIDE HOISTWAY Counterweight & counterweight buffer Floor & emergency identification numbering Hoistway construction Hoistway smoke control

Standby power operation Restricted opening of car or hoistway doors Car ride MACHINE ROOM Headroom Access to machine space Lighting and receptacles Enclosure of machinery space Housekeeping Ventilation Fire extinguisher Pipes, wiring and ducts Guarding of exposed equipment Numbering of elevators, machines and disconnect switches Disconnecting means & control Controller wiring, fuses, grounding Static control Overhead beam and fastenings

CODE VIOLATIONS: *Per R.I.G.L. 23-33-24, violations must be abated within 30 days from the above inspection date.

Please Print FOUR COPIES: DLT - 1, Elevator Co - 1, Customer - 1 and Machine Room - 1