Minnesota Department of Labor and Industry

Construction Codes and Licensing Division

Elevator Inspections
443 Lafayette Road North
St. Paul, MN 55155-4341
Phone: (651) 284-5071
Fax: (651) 284-5749
www.dli.mn.gov

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Escalator Inspection Report

PRINT IN INK or TYPE

LOCATION

COUNTY

ADDRESS

CITY

NORMAL DIRECTION OF TRAVEL:

ESCALATOR SERVES

OWNER ID NO.
STATE

ZIP CODE

STATE ID NO.

UP
DOWN
UP AND DOWN
LEVEL TO
LEVEL
ASME Inspection Standard to be applied for this unit: Year of Installation
People per hour (pph) Total travel (ft) Rated speed (fpm)
NOTES:
Step Skirt Performance Index
Has the escalator skirt been cleaned?

Yes

Did the index polycarbonate test specimen meet the following criteria:
Material:
Polycarbonate without fillers.
No
Yes
No

Is all equipment calibrated and current?

Yes

No Color: Natural, no pigments.

Yes

No

Was the unit tested in the normal direction of travel?

Yes

No Finish: Glossy (roughness less than 0.32 uin.

Yes

No

Was the applied load 25 lbf?

Yes

Did it deviate more than +/- 2.5 lbf?

Yes

No Area in contact with skirt plane: 4.5+/-0.5in2 and

at least 0.03in thick.
No

Yes

No

Is the distributed load area between 3in2 & 6in2

Yes

Does this unit have skirt deflection devices?

At what intervals was the index recorded?

No Specification: GE Lexan 100 series or equivalent

polycarbonate.
No

Yes

No

Yes

Left
What were the Step/Skirt Performance Index measurements?
How many readings per side were taken during the test? (Identified when looking up from the bottom on
the unit.)
CHOOSE ONE OF THE FOLLOWING THREE ITEMS as described in ASME A17.1a 2005 Item 8.6.8.3.3

Right
Left

Right

Condition 1: All units range < 15

Condition 2: Escalators installed under ASME A17.1a-2002 and later editions Range: < .25 with skirt deflection devices.
Condition 3: Escalators installed under ASME A17.1-2000 and earlier editions Range: < .4 with skirt deflection devices.
Did the escalator meet one of the applicable conditions above using the highest measurement obtained?

Yes

No

Have all readouts been attached to this form? Must be submitted for each test, properly labeled and dated?

Yes

No

DID THE UNIT PASS ALL TESTING REQUIREMENTS PRIOR TO BEING RETURNED TO SERVICE?
Brake Lining Condition:
Machine Room Light:
Broken Drive Chain Device:
Machine Room Stop Switches:
Broken Step Chain:
Missing Step Device:
Comb Step Impact Devices:
Reversal Stop Device:
Demarcation Lighting:
Reverse Phase Relay:
Disconnected Motor Device:
Rolling Shutter Device:
Drain in Bottom for Outside Escalators:
Signage:
Drain Chain Tension:
Skirt Switches:
Emergency Stop Buttons:
Speed Governor:
Handrail Chain Tension:
Step Chain Tension:
LH
RH
Handrail Entry Device:
Step Level Device:
LH
RH
Handrail Monitoring Device:
Step Rollers:
Top
Bottom
Landing Plate Switches:
Step Upthrust Device: Top
Lockable Fused Disconnect/CircuitBre
Step Upthrust Device: Bottom

Yes

No

Machine Room Cover Switches:

Top

Bottom

Top
Top

Bottom
Bottom

LH

RH

LH
LH

RH
RH

Tandem Operation Interlock Device:

COMPANY CONDUCTING TEST

NAME OF PERSON CONDUCTING TEST

ADDRESS

SIGNATURE OF PERSON CONDUTING TEST

CITY

STATE

ZIP CODE DATE

This material can be made available in different forms, such as large print, Braille or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or
TDD (651) 297-4198.
EL003 (10/08)