HomeMy WebLinkAboutHydraulic Elevator Safety Test Report 03.19.25Nmt6;
COUNCIt Of GOVERNMENTS
ELEVATOR INSPECTION PROGRAM • •
Elevator Safety Test
o
Building Name CRM School- Bar Fork
Manufacturer TKE
OPS Conveyance # CP'i7m@46f;i,-
E
Address 500 Holden Way
Install Date 3/19/2025
Local Conveyance ID
0
`_S
City Carbondale
Zip Code 81623
Capacity (lbs) 2,500
Stops 2
Job/Contract # EHC593
ro
�5
100 up Rated Speed (fpm)
125 down
Inspector Present Yes ❑ No If Yes, inspector signs report
Duty VPassenger ❑Freight 7MRL
O
Freight Class B ❑ C
Test Date 3/19/2025
Type of test EZAcceptance ❑ Annual (Cat 1) Witnessed (Cat 1 or 5)
,a
Piston Diameter (in) 3" Relief valve setting (psi) Adjustment needed? ❑ Yes 0i No
(set at 150% or less of working pressure) Adjustment sealed? (Yes ❑ No
�
No load working pressure (psi) � �
Full load working pressure (psi): 3 W (n NIA performed at acceptance tests only) /
Plunger Gripper operational (rated load)? ❑Yes ❑ No (RN/A Cat 1 only)
Over -speed valve operational? O(Yes ❑ No (:1 N/A Cat 1 only)
All hydraulic system visable: k Yes ❑ No
Proper fuses installed? 14 Yes ❑ No
Connections tight? K Yes ❑ No
Controller clean?OYes [I No
Jumpers removed? U(Yes ❑No
of
yes, sipthe static test
a5
,tom
Elapsed time (mint' k N/A(ifstatic
Change in car position? ❑ Yes ❑ No If yes, distance (in)�/
3 m
Sf31,C tests are t 5min test not required)
O
rn
Oil loss accounted for? ❑ Yes ❑ No '&N/A
NOTE If any oil loss cannot be accounted for, the elevator must be removed from service and the Authority Having Jurisdiction must be noti`ied
Stop switches In car: KPass ❑ Fail Pit: rVPass ❑ Fail Top of car: 0( Pass ❑ Fail
Directional limits Up: J-Pass ❑ Fail Down: &Pass ❑ Fail
Final limits Up: ❑ Pass ❑ Fail�N/A Down: ❑ Pass ElFail',(,N/A
aN
Low -oil protection Pass El Fail ❑ NIA (Code year 1993)
Escape hatch contact Pass El Fail El N/A
O
Low Pressure switch XPass7 Fad
Re -level during manual lowering X Pass [I Fail [I N/A
❑ N/A If cylinder is below stora a tank Code ear 1981
All electrical protective safety devices operate as intended XPass ❑ Fail (Code reference A17 1 2 26 2)
Closing force (max. 30 Ibf) ,) 3
Mechanical edge ❑ Pass ❑ Fad 0 N/A
Electronic edge It Pass ❑ Fail ❑ N/A
0
C)
Closing time (sec)
Door monitoring XPass ❑ Fad (❑ N/A prior to 2019)
Door guides X Pass ❑ Fad
Door restriction XPass ❑ Fail 7 N/A
Door interlocks/gate switch )Vass 7Fad
Phase I recall K, Pass ❑ Fad ❑ N/A (Code reference 8.6)
Fire service signage in place? t5 Yes ❑ No ❑ N/A
o
Phase II operation rPass ❑ Fad ❑ N/A
Remove fire contacts to test fire service N Pass ❑ Fail ❑ NIA
rn ro
E tv
Emergency communication 29 Pass ❑ Fail ❑ N/A
Emergency lights i5Pass ❑ Fail -- N/A
w O
Alarm bell Pass ❑Fail ❑N/A
Emergency power operation ❑ Pass ❑ Fail D(N/A Not<
Battery lowering (Pass —1 Fail 7 NIA
125° ofreledloadreq.-dateccepi—, O Need to return, Second form
v
MCP logs updated Yes ❑ No (Per state Pegs 2.3-3-3c) I
Test tag installed? NYes - No
-C
O
All Test Requirements ❑ Pass" ❑ Fail 'Pass may be checked only if all items on this test form meet adopted code requirements
By signing below I certify all statements are true to the best of my knowledge and that all testing was performed according to current adopted codes.
En
Mechanic name �- I-NI)l, C, i I
Contractor company name
Mechanic signature
J Date C State license # _ _ (
N
at
`n
Inspector name 7& J
I %
Inspection cone any name �(�/LL O 4:
Inspector signature: Date � / a State license #.G�• �.�8y
A,, 6-te r c y6-c of : f,1*0Test Form Revised August 2023
0$6;r.<