Facility / Building Name
Property Address
Certified Elevator Technician
Service / Inspection Date
Elevator Bank / Car Identifier
Passenger
Freight
Service (Car ID / Bank):
Drive System Type
Geared Traction
Gearless Traction
Hydraulic
Machine Room-Less (MRL)
State / Municipal Permit Number
Perform these maintenance steps for each vertical transportation unit during inspection:
Action Item | Check? | ||
|---|---|---|---|
A | B | ||
1 | Machine Room & Traction Drive Inspection: Inspect brake shoes, drive sheaves, and gearboxes for smooth operation, proper oil level, and signs of leakage. Vacuum carbon dust from motor windings and controller cabinets. Never clean high-voltage electrical cabinets with conductive or liquid cleaners. | ||
2 | Hoistway Cable & Governor Wire Rope Servicing: Perform a visual and physical tactile check of steel suspension ropes, governor cables, and compensation chains for fraying, broken wire strands, necking, or rust. Verify counterbalance cable tension across all strands. | ||
3 | Guide Rail & Shoe Lubrication Check: Clean debris from guide rail channels. Verify roller guide wheels or sliding guide shoes are lubricated and aligned, minimizing car vibration and cab drift. | ||
4 | Hoistway Door Interlocks & Hanger Roller Maintenance: Inspect door hangers, tracks, relate cables, and door clutch assemblies at each floor landing. Clean dirt and debris from hall door sill grooves to prevent door binding. | ||
5 | Car Sill & Cab Door Safety Edge Testing: Test electronic light curtains and mechanical door safety edges to ensure immediate door reopening when obstructed during the closing cycle. | ||
6 | Emergency Power, Lighting & Communication Test: Test two-way in-car emergency phone or intercom system to confirm direct connectivity to dispatch or monitoring center. Verify battery backup operation for cabin emergency lighting, alarm bell, and emergency lowered floor positioning. |
Use one row per elevator car or mechanical subsystem. Record mechanical status, structural alignment, safety system responses, and actions taken.
Subsystem / Zone | Subsystem Type (Traction Drive, Governor, Cab Doors, Car Sling, Pit) | Mechanical & Brake Integrity (Brake Hold, Cable Tension, Fluid Levels) | Electrical & Controller Status (Relays, Contacts, Fuses, Wiring) | Door Operation & Interlocks (Smooth, Reversing, Locked, Alignment) | Safety & Emergency Features (Phase I/II Fire, Intercom, Light Curtain) | Maintenance / Action Taken | Follow-up Required? (Yes / No) | ||
|---|---|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | G | H | ||
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Use these standard codes when logging equipment defects or code safety violations:
Component Severity Rating
Specific Defect Codes
Document elevator subsystems requiring immediate OEM parts replacement, cable reshoring, or specialized contractor intervention.
Subsystem | Status / Rating Code | Specific Component Needing Repair / Replacement | Manufacturer / Part # | Estimated Cost | Priority Level (Immediate / Life Safety, Scheduled, Monitor) | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
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10 |
Elevator Inspector / Technician Signature
Building Operations Manager Signature
Form Template Insights
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Mandatory Questions Recommendation
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1. Service Date, Building Name & Elevator Car Identifier
2. Certified Elevator Technician & Operations Manager Signatures
3. Are all steel suspension ropes free from crown wire breakage, rouging (rusting), and unequal tension?
4. Is the traction drive brake system operating smoothly with proper shoe lining clearance and zero oil contamination?
5. Are all electromechanical landing door interlocks functioning, aligned, and passing continuity checks?
6. Are the electronic door edges or infrared door light curtains fully functional across all blind spots?
7. Is the two-way in-car emergency communication phone/intercom operational and connecting directly to monitoring staff?
8. Do Phase I and Phase II Emergency Fire Service Recall key switches actuate correctly?
9. Is the elevator car safe for public passenger service, or must it undergo immediate Lockout / Tagout?
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