Elevator Boiler and Amusement Ride Bureau OFFICE USE ONLY

1000 East Grand Avenue Receipt Date

Des Moines, Iowa 50319-0209
Phone: 515-281-5415
Scheduled Inspection Date
Fax: 515-242-5076
http://www.iowaworkforce.org/labor/elevator_forms.htm

Acceptance Checklist
For installations of new elevators, the elevator contractor and general contractor must complete and submit this form to the address
provided above at least two business days prior to an acceptance inspection. Use of this form does not change how acceptance
inspections are scheduled; however, failure to file this form on time will result in cancellation of a scheduled inspection. This
Acceptance Checklist is a general list of frequent problems discovered during elevator inspections and is not a substitute for the
applicable codes.

To receive advice regarding the work needed for an elevator to pass inspection from a state elevator inspector prior to an inspection,
you may contact 515-281-5415 and ask to schedule a consultative inspection. The fee for a consultative inspection is $100.00 per
hour with a $200.00 minimum.

The following items shall be completed and tested by the appropriate contractor(s) prior to the acceptance inspection. If a
re-inspection is necessary, a fee of $200.00 will be charged.

Building Name State ID No. Owner’s ID

Address

City State Zip Code

Elevator Contractor/Contact Person Elevator Contractor/Contact Phone

General Contractor/Contact Person General Contractor/Contact Phone

Elevator Machine Room and/or Control Space

Requirements Reference Code Completed
1) Provide and install a wall-mounted ABC fire extinguisher (5 lb. minimum) ASME A17.1 Yes No
in the machine room and/or control space. 8.6

2) Provide a machine room and/or control space door closer and self- ASME A17.1 Yes No
locking lockset. Door must be operable from inside machine room 2.7.3.4 or 3.7.1
and/or control space without a key. Lock must not be part of a building
master system.

1
Elevator Machine Room and/or Control Space (continued)
Requirements Reference Code Completed
3) Install a code compliant means of accessing the machine room and/or ASME A17.1 Yes No
control space. 2.7.3.3 or 3.7

4) Install a separate branch circuit for the machine room and/or control NFPA 70 Yes No
space light and receptacles. Lighting cannot be on load side of GFCI. 620.22

5) Provide a fused disconnect or circuit breaker to disconnect all NFPA 70 Yes No

ungrounded conductors for each elevator. Disconnecting means shall be 620.51
capable of being locked in the open position. Proper labeling shall
be installed.

6) Provide the machine room and/or control space lighting with 19 foot- ASME A17.1 Yes No
candles of illumination at floor level. 2.7.9 or 3.7.1

7) Install a machine room and/or control space door assembly which is ASME A17.1 Yes No N/A
properly rated and labeled. 2.7.1 or 3.7.1

8) Provide the machine room and/or control space with means of ASME A17.1 Yes No
controlling the temperature and humidity per elevator manufacturer’s 2.7.9 or 3.7.1
recommendation.

9) Provide venting in the machine room and/or control space with the ASME A17.1 Yes No N/A
proper fire dampers in penetrations. 2.7.1 or 3.7.1 (also see
IBC section 3004.2)

10) Provide the machine room and/or control space with the same fire ASME A17.1 Yes No N/A
rating as the hoistway. This requirement is applicable when the machine 2.7.1 or 3.7.1
room and/or control space is located adjacent to the hoistway.

11) Provide automatic means to remove power from the elevator controls NFPA 70 Yes No N/A
prior to application of water if a sprinkler is installed in the machine room, 620.51 (B)
control space, and/or hoistway. Where required heat detectors shall also be ASME A17.1
within 24” of each sprinkler. 2.8.3.3.4

12) Install smoke detectors to recall the elevator in the following manner: ASME A17.1 Yes No
Smoke detectors located in machine room and/or control space shall 2.27.3 or 3.27, NFPA 72
recall elevator to a designated landing site. If the machine or control area
is located at the designated landing site, the elevator shall recall to an
alternate landing site.

13) Remove all pipes, ducts, conduits or other equipment not directly ASME A17.1 Yes No
related to elevator operation from the hoistway, machine room, control 2.8 or 3.8
space, and/or the machine area.

14) Store all keys needed to access the machine room and control space, as ASME A17.1 Yes No
well as all keys needed to operate all elevator equipment, on site and in a 8.1.1
location accessible only to authorized personnel.

15) Test and adjust all elevator equipment, including governors, safeties, ASME A17.1 Yes No
and valves. 8.10.2.2

16) Test the emergency power system prior to inspection. ASME A17.1 Yes No N/A
2.27.2

2
Elevator Hoistway and Pit
Requirements Reference Code Completed
17) Provide a GFCI protected outlet in the machine space. NFPA 70 620.23(C), Yes No
620.85

18) Provide a separate, single, and non-GFCI outlet for sump pump use NFPA 70 620.85 Yes No
only.

19) Provide a pit drain or pit sump pump not connected directly to a sewer ASME A17.1 Yes No N/A
and capable of removing 50 gallons per minute for elevators with fire 2.2.2 or 3.2
emergency recall.

20) Install heat detectors within 24 inches of the sprinkler. Sprinklers NFPA 72 6.16.4.2 Yes No
installed within 24 inches of the pit floor are not required to disconnect the
main power supply to the elevator.

21) Remove all debris from hoistway, pits, machine room and/or control ASME A17.1 Yes No
area, and cartops. 8.6.12.3.2

22) Install hoistway venting to comply with applicable local regulations. In IBC 3004.3 Yes No
the absence of local regulation, the International Building Code (IBC) shall
apply. IBC states that all elevators penetrating more than three stories
require hoistway venting. Vent shall be 3.5 percent of hoistway area or a
minimum of three square feet.

23) Install NEMA 4 electrical equipment and wiring to all electrical ASME A17.1 Yes No N/A
equipment located less than 48” above the pit floor when sprinklers are 2.8.3.3.4
installed in hoistways. All wiring and equipment shall be suitable for use in
wet locations. Exceptions may apply.

24) Provide a code- compliant pit ladder within reach of access door. ASME A17.1 Yes No
2.2.4

25) Provide a guarded light in the pit with minimum of 10 foot-candle at ASME A17.1 Yes No
floor level. Light switch shall be accessible from pit access door. Lighting 2.2.5.1
cannot be on the load side of GFCI. NFPA 70 620.24

26)Provide a 120-volt, 20-amp, GFI receptacle in pit. Separate branch circuit ASME A17.1 Yes No
shall be provided for pit light and receptacle. 2.2.5
NFPA 70 620.24(C)

27) Remove all conduit, piping or duct located in the hoistway not directly NFPA 70 620.37 Yes No
related to elevator operation.

28) Install 75 degree bevels on all projections and recesses into the ASME A17.1 Yes No
hoistway greater than 4” on all sides not used for loading or unloading. 2.1.6.2

29) Install devices to initiate phase 1 recall at each floor served, in the ASME A17.1 Yes No
machine room or control space, and in the hoistway if it has a sprinkler. 2.27.3.2.1
Initiating devices in a hoistway without a sprinkler may only operate NFPA 72 6.16.3
hoistway ventilation. NFPA 72 6.16.3.6

3
Elevator Lobbies and Cars
Requirements Reference Code Completed
30) Install and label the hoistway key-operated vent-switch. The hoistway IBC 3004.3 Yes No N/A
key-operated vent-switch must be removable in closed position and located
adjacent to fire control panel (if provided), or in the elevator lobby of the
designated floor.

31) Provide finished car flooring. Flooring shall be substantially flush with ASME A17.1 Yes No
doorsill. 2.14.1.9.2

32) Floor material at each landing entrance shall be installed so there is no ASME A17.1 Yes No
tripping hazard. Entrance sills must be grouted or otherwise provided with 2.11.11
means to support the loads imposed.

33) Provide permanent hall lighting at each landing entrance. Lighting shall ASME A17.1 Yes No
not be less than 10 foot-candles at sill with doors in closed position. 2.11.10.2

34) Phase I and II fire/emergency recall must be tested to assure proper NFPA 70 21.2.12 Yes No
operation before inspection. Qualified personnel must be at the inspection
to test the initiating devices.

35) Lobby initiating devices shall be mounted on the ceiling within 21 feet NFPA 72 6.16.3 Yes No
of elevator landing or entrance area.

36) Provide an elevator corridor call station pictograph at each corridor call ASME A17.1 Yes No
station. 2.27.9

37) Install a two-way communication means between the car and a location ASME A17.1 Yes No
staffed by authorized personnel. 2.27.1

38) Provide the following documents at the time of inspection for review ASME A17.1 Yes No
on site by elevator inspector: Maintenance Control Program, Maintenance 8.6.1.2.1
Record, and Code Data Plate.

This form must be received at least two business days prior to the scheduled inspection date.

Within the scope of my company’s responsibilities, I have verified completion for each item listed above. To the best of my
knowledge the conveyance is ready to pass inspection.

GENERAL CONTRACTOR (PRINT NAME) ELEVATOR CONTRACTOR (PRINT NAME)

GENERAL CONTRACTOR (SIGN NAME) ELEVATOR CONTRACTOR (SIGN NAME)

DATE DATE

309-6113 06-12
4