Free 34599.pdf - Indiana

REPORT OF TESTS FOR ELEVATOR, DUMBWAITERS, ESCALATORS, PLATFORM LIFT, STAIRWAY CHAIRLIFTS, PEOPLE MOVERS AND SPECIAL PURPOSE ELEVATORS
State Form 34599 ( R6/8-05)

DIVISION OF FIRE & BUILDING SAFETY DIVISION OF ELEVATOR SAFETY 402 W. Washington St., Room W246 Indianapolis, Indiana 46204 (317) 232-2670

http://www.in.gov/dhs/fire

INSTRUCTIONS: File this form with Division of Elevator Safety within 30 days after test completion.
Date (month, day, year) Name of Inspector Name of User Address of user (number, street, city, state, zip code) Name of Contractor Name of Witness ­ QEI # INDIANA LIC # Signature of Mechanic License Number Date Signed (month, day, year)

GENERAL INFORMATION
State Number Name of manufacturer Type of unit ­ Pass, Freight, SPPE, PPM , DW, VWL, IWL, ICL,ESC, MW Capacity Drum, traction or hydraulic? Rated speed Type of buffers Buffer stroke Materials of rails Governor type Steel Flyball A Wood Centrifugal B C Spring Oil # # # # #

Type of Safety Devices

5 YEAR ELECTRICAL TEST
No load speed up No load speed down Rated load speed up Rated load speed down Overspeed switch Trip speed Slide Oil buffer plunger return time Brake test (with 125% of rated load) Stand by emergency power operation Emergency terminal speed limiting device

ANNUAL TEST ELECTRIC
Oil buffer plunger return time Safety devices Governor Slack rope Normal terminal stopping devices Obstruction devices Final terminal stopping devices Firefighters service Stand by emergency power operation Power operation of door system Lbs. Lbs. Lbs. Lbs. Lbs.

ACCEPTANCE TEST HYDRAULIC
STATE NUMBER No load speed up No load speed down Rated speed up Rated speed down Working pressure Relief valve setting Shut-off valve Static load Test (1006.1) 15 minutes # # # # #

ANNUAL TEST HYDRAULIC
Oil buffer plunger return time Safety devices Governor Relief value setting
Emergency terminal speed limiting device

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Normal terminal stopping device Final terminal stopping device Firefighters service Stand by emergency power operation Power operation of door system Static load test (1005.2B) 15 minutes

MOVING WALK AND ESCALATOR TEST REQUIREMENTS
STATE NUMBER ESCALATOR MOVING WALK

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Speed governors Escalator broken step-chain device Each step inspected for structural damage Broken drive chain devices Moving walk broken treadway devices Stop switches Fire shutters Escalator skirt ­ obstruction device Brakes Starting switches Escalator reversal stop devices Escalator step upthrust devices

BELTED MANLIFTS TEST REQUIREMENTS
STATE NUMBER Up capacity Down capacity ­ Brake Load step deflection Strength of hand hold Safety stops Movable cone guards Speed tests # # # # #