LIFT EXAMINATION REPORT (PRA-PEKALA)

Electric Passenger / Goods Passenger / Hydraulic Lift / MRL

Owner's Name & Address : _______________________________________________________________________________________________

Building Name & Address : _______________________________________________________________________________________________
Occupier's Name & Address : _______________________________________________________________________________________________
Brand : _________________________ Model : _________________ Lift No : ________________
Serial No : _________________________ Motor Power : ____________ KW Travel : ________________ M
Rated Load : _________ KG ________ Persons Rated Speed : ___________ mps Floors / Openings : ____________

(1) MACHINE ROOM / SPACE G NG NA (4) INSIDE HOISTWAY G NG NA

1.1 Safe access to LMR or machine space 4.1 Hoistway construction
1.2 Door securely locked with signages 4.2 Pipes, wiring and ducts
1.3 Housekeeping 4.3 Travelling cables, junction boxes
1.4 Adequate Lighting and receptacle 4.4 Guide rails securely fastened
1.5 Adequate and effective ventilation 4.5 Governor rope
1.6 Emergency Power Unit (EBOPS) 4.6 Suspension ropes
1.7 Fire extinguisher 4.7 Compensating ropes or chains
1.8 Conduits, Trunking and earthing 4.8 Rope guards correctly fitted on cwt. sheave
1.9 Machine sheave and floor opening guarding 4.9 Filler weight securely fastened
1.10 M/c securely supported & fixed in position 4.10 Counterweight sheave shaft and bearing
1.11 Safe means of access to all lift equipment 4.11 Counterweight shoes or roller guides
1.12 All equipment are correctly identify and label (5) LANDING FLOOR G NG NA
1.13 Machine brake operation 5.1 Approved firm and emergency contact no.
1.14 Motor gears and bearings 5.2 Hall panel buttons and Indicator
1.15 Handwinding device / Brake releaser 5.3 Landing door operation
1.16 Traction sheave and grooves 5.4 Landing door & gap
1.17 Secondary & deflector sheaves 5.5 Landing door contact switches
1.18 Rope fastening at terminations 5.6 Effective mechanically door locking
1.19 Governor overspeed device and switch 5.7 Landing door unlocking device
2) INSIDE OF CAR G NG NA (6) PIT G NG NA
2.1 Door reopening device 6.1 Access and lighting
2.2 Car operating panel and buttons 6.2 Emergency stop switches
2.3 Car lighting & ventilation 6.3 Pit clean and dry
2.4 Car emergency alarm bell 6.4 Bottom clearance and refuge space
2.5 Intercom System 6.5 Down final limit switch
2.6 Car door or gate 6.6 Governor rope tension device and switch
2.7 Load capacity data plate, PMA and signages 6.7 Safety operating switch
2.8 Car door locking device 6.8 Car frame and platform
2.9 Car floor, ceiling and sill 6.9 Car safeties & cwt safeties
(3) TOP OF CAR G NG NA 6.10 Compensating chains, ropes & sheave
3.1 Car top emergency stop switch 6.11 Car and counterweight buffers
3.2 Car top lighting and 3-pin power socket 6.12 Car and counterweight buffer switches
3.3 Car top inspection panel and buttons 6.13 Car and counterweight buffer bottom runby
3.4 Car overhead, pulley/sheaves 6.14 Sufficient car top clearance for overtravel
3.5 Car shoes or roller guides 6.15 Cwt. and common lift shaft guarding
3.6 Emergency terminal stopping devices (7) RIDE OPERATION G NG NA
3.7 Up final limit switch 7.1 No unusual noise or vibration during running
3.8 Emergency exit hatch and switch 7.2 Leveling accuracy acceptable
3.9 Car top railing and guarding
Legend : G = Good, NG = No Good, NA = Not Applicable

(Page 1/2) Revision : 13 Dec 2024

LIFT EXAMINATION REPORT (PRA-PEKALA)

TEST ITEMS & REQUIREMENTS TEST RESULT DATE TESTED

a) Car buffer test

i) Load ____________ (KG) and Speed ____________ MPS YES / NO / NA

b) Conterweight buffer test

i) Load ____________ (KG) and Speed ____________ MPS YES / NO / NA

c) Car safety gear test

i) Load ____________ (KG) and Speed ____________ MPS YES / NO / NA

d) Counterweight safety gear test

i) Load ____________ (KG) and Speed ____________ MPS YES / NO / NA

e) Governor tripping speed test

i) Electrical tripping speed _________ m/s YES / NO / NA
ii) Mechanical tripping speed ________ m/s YES / NO / NA

f) Car door locking device

i) Prevent trapped passenger from self rescue YES / NO / NA

g) EBOPS (Emergency Battery Operated Power Supply)

i) Car lighting YES / NO / NA
ii) Car ventilation fan YES / NO / NA

h) Illumination
i) Machine Room YES / NO / NA
ii) In-side Car YES / NO / NA
iii) Car top YES / NO / NA
iv) Lift pit YES / NO / NA

i) Load weighing device

i) test manually at no load YES / NO / NA
ii) test with rated load YES / NO / NA

j) Brake Test
i) test with 125% rated load at lowest landing YES / NO / NA

k) ACOP
i) Load ____________ KG and Speed _________ MPS Direction : Up / Down YES / NO / NA

l) UCMP
i) Load ____________ KG and Speed _________ MPS Direction : Up / Down YES / NO / NA

Legend : YES = Satisfactory, NO = Failed, NA = Not Applicable

Comment :

Signature : Name of Qualified Person : Registration No. of Lift Qualified Person : Date :

(Page 2/2) Revision : 13 Dec 2024