Service Tech Name(required) Customer #(required) Customer Name Phone # Address City, State Model # Serial # 1. Access to Pit(required) Pass Repair ANSI N/A Comments 2.Pit Light & Switch(required) Pass Repair ANSI N/A Comments 3. Pit Stop Switch(required) Pass Repair ANSI N/A Comments 4. Condition of Pit(required) Pass Repair ANSI N/A Comments 5. Counterweight Buffer Spring(required) Pass Repair ANSI N/A Comments 6. Car Buffer Springs(required) Pass Repair ANSI N/A Comments 7. Counterweight Condition(required) Pass Repair ANSI N/A Comments 8. Counterweight Connections(required) Pass Repair ANSI N/A Comments 9. Counterweight Run-by(required) Pass Repair ANSI N/A Comments 10. Compensation Chain-Rope(required) Pass Repair ANSI N/A Comments 11. Governor Take-up Device(required) Pass Repair ANSI N/A Comments 12. Governor Cable Condition(required) Pass Repair ANSI N/A Comments 13.Governor Connection Condition(required) Pass Repair ANSI N/A Comments 14. Bottom Terminal Limit Switch(required) Pass Repair ANSI N/A Comments 15. Bottom Final Limit Switch(required) Pass Repair ANSI N/A Comments 16. Trail Cord Guide - Cables(required) Pass Repair ANSI N/A Comments 17. Car Condition(required) Pass Repair ANSI N/A Comments 18. Car Light & Switch(required) Pass Repair ANSI N/A Comments 19. Car Emergency Stop Switch(required) Pass Repair ANSI N/A Comments 20. Car Emergency Signal Device(required) Pass Repair ANSI N/A Comments 21. Car Controls(required) Pass Repair ANSI N/A Comments 22. Car Door & Switch(required) Pass Repair ANSI N/A Comments 23. Emergency Escape Hatch & Switch(required) Pass Repair ANSI N/A Comments 24. Car Safety Show Condition(required) Pass Repair ANSI N/A Comments 25. Car Brake Switch(required) Pass Repair ANSI N/A Comments 26. Car Condition(required) Pass Repair ANSI N/A Comments 27. Car Capacity Sign(required) Pass Repair ANSI N/A Comments 28. Car Door Interlock Safety(required) Pass Repair ANSI N/A Comments 29. Car Top Stop Switch(required) Pass Repair ANSI N/A Comments 30. Car Top Light(required) Pass Repair ANSI N/A Comments 31. Car Retiring Cam - Stationary(required) Pass Repair ANSI N/A Comments 32. Car Conduit Connections(required) Pass Repair ANSI N/A Comments 33. Car Guides - Roller Conditions(required) Pass Repair ANSI N/A Comments 34. Car Guide Rail Condition(required) Pass Repair ANSI N/A Comments 35. Counterweight Guide Rail/Enclosure(required) Pass Repair ANSI N/A Comments 36. Top Terminal Limit Switch(required) Pass Repair ANSI N/A Comments 37. Top Final Limit Switch(required) Pass Repair ANSI N/A Comments 38. Drive Unit Weather Protection(required) Pass Repair ANSI N/A Comments 39. Machine Room Receptacle & Light(required) Pass Repair ANSI N/A Comments 40. Machine Guarding(required) Pass Repair ANSI N/A Comments 41. Machine Flooring(required) Pass Repair ANSI N/A Comments 42. Access to Drive(required) Pass Repair ANSI N/A Comments 43. Access to Drive Platform(required) Pass Repair ANSI N/A Comments 44. Car Clearance(required) Pass Repair ANSI N/A Comments 45. Counterweight Clearance(required) Pass Repair ANSI N/A Comments 46. Drive Unit Disconnect(required) Pass Repair ANSI N/A Comments 47. Unintended Car Movement Device(required) Pass Repair ANSI N/A Comments 48. Ascending Car Overspeed Device(required) Pass Repair ANSI N/A Comments 49. Projections in Hoistway(required) Pass Repair ANSI N/A Comments 50. Recesses in Hoistway (required) Pass Repair ANSI N/A Comments 51. Hoistway Lighting(required) Pass Repair ANSI N/A Comments 52. Emergency Ladder(required) Pass Repair ANSI N/A Comments 53. Emergency Platforms(required) Pass Repair ANSI N/A Comments 54. Drive Unit Condition(required) Pass Repair ANSI N/A Comments 55. Drive Unit Oil Level(required) Pass Repair ANSI N/A Comments 56. Drive Unit Bearing Condition(required) Pass Repair ANSI N/A Comments 57. Governor Condition(required) Pass Repair ANSI N/A Comments 58. Governor Limit Switch Condition(required) Pass Repair ANSI N/A Comments 59. Traction Sheaves(required) Pass Repair ANSI N/A Comments 60. Deflector Sheaves(required) Pass Repair ANSI N/A Comments 61. Hoist Cable Condition(required) Pass Repair ANSI N/A Comments 62. Electrical Control Panel(required) Pass Repair ANSI N/A Comments 63. Trail Cord Electrical Condition(required) Pass Repair ANSI N/A Comments 64. Landing Door Unlock Device(required) Pass Repair ANSI N/A Comments Submit Δ
Koehl Bros 
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