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Elevator & Lift Incident Report

LAGUNA WOODS VILLAGE SECURITY DIVISION
ELEVATOR & LIFT INCIDENT REPORT
S-CODE – 0185 – ELEVATOR PROBLEM/CHAIR LIFT
Routing: Project Engineer I
Form 400-601 rev 12/3/16 (rs)

CASE # :

LOCATION

BLDG # -APT # :

STREET / INTERSECTING STREET :

P

PHASE #

D

BLOCK #

RP

LAST NAME

FIRST NAME :

BLDG-APT # :

ID # / PASS # :

PHONE :

WC :


INVOLVEMENT :


IDENTITY :

SECTION 1: GENERAL INSPECTION, check all that apply

POWER OUTAGE TO BUILDING      No further action. DO NOT call Elevator Service. DO NOT post Out of Order signs.

OCCUPANT TRAPPED, OR INJURED BY ELEVATOR; Call OCFA and Elevator Service.      Long form IR required

IF NEITHER OF THE ABOVE CONDITIONS APPLIES, PRESS CALL BUTTON LIGHT AT GROUND/FIRST FLOOR. IS IT ON?

NO      Post “Out of Order” signs and call the Elevator Service. No further action required.

YES      Complete Elevator Testing Procedure listed below.

ELEVATOR TESTING PROCEDURE:

  1. CALL ELEVATOR TO THE GROUND/FIRST FLOOR. RIDE ELEVATOR TO THE THIRD FLOOR.
  2. STEP OUT OF THE ELEVATOR & LET DOORS CLOSE.
  3. PRESS THE CALL BUTTON & STEP IN THE ELEVATOR ONCE THE DOORS OPEN.
  4. RIDE THE ELEVATOR DOWN TO THE NEXT FLOOR.
  5. REPEAT STEPS 3 AND 4 UNTIL BACK TO THE LOWEST FLOOR.
  6. COMPLETE OBSERVATIONS IN THE SECTIONS BELOW.
SECTION 2: UNUSUAL NOISES
NONE

FLOOR:

GROUND   FIRST   SECOND   THIRD  

NOISE DESCRIPTION:

GRINDING   HUMMING   BUZZING   CHATTERING   OTHER:  

NOISE LOCATION::

DOORS   ABOVE ELEVATOR   MACHINE ROOM   BELOW ELEVATOR   OTHER:  

SECTION 3: ELEVATOR DOORS
NONE
SLOW   SCRAPING   SLAMMING   REOPENING INTERMITTENTLY   DOORS STUCK OPEN AT FLOOR #  
OTHER:  

SECTION 4: MISCELLANEOUS ITEMS:
NONE
LIGHTS OUT   SLOW OPERATION   EXCESSIVE VIBRATION   PHONE OUT OF SERVICE   STOP SWITCH PULLED UPON ARRIVAL  
ODOR:      OTHER:     

SECTION 5: DISPOSITION
AMTECH ELEVATOR CONTACTED:      OUT OF ORDER SIGNS POSTED   NO PROBLEMS FOUND / OPERATION OK  

OTHER ELEVATOR CO. CONTACTED:      PROBLEM RESOLVED BY OFFICER   OTHER:  

SERVICE REQUEST # (SSR):  

ADDITIONAL INFORMATION: