Periodic Test Witness Report Form

With the adoption of the A17.1-2013 edition of the A17.1 code, Inspectors in Florida and many of the States and Jurisdictions that have also adopted the A17.1-2013 edition of the A17.1 code have a new requirement ( Requirement Periodic Tests) to report information to the Authority Having Jurisdiction (AHJ) that they may not be aware of or understand how to report this information. Understandably, some AHJ's may have exempted inspectors from this requirement and you must verify with your applicable AHJ if they have exempted this requirement. While some of the AHJ's have developed reporting forms and procedures for this information, many have not and the burden of this reporting is the inspector's responsibility.

The A17.1 code states the inspector shall submit a signed written report to the authority having jurisdiction containing specific information. Some of the information required for submission includes but is not limited to date of inspection(s); type of test(s) performed; detailed results of the test(s) including but not limited to, speed, governor trip speed, safety slide distance, relief valve setting, escalator/moving walk brake torque setting, etc.; Code deficiencies noted during the test and statement as to any corrective action taken.

We have developed a basic form for reporting these test witnessing requirements that we believe is fairly compliant with the actual code requirement.

We invite all Elevator Inspectors, Elevator Consultants, Elevator Enforcement Authorities and anyone else that have a need to report these test witnessing results in accordance with the A17.1-2013 and later editions of the SAFETY CODE FOR ELEVATORS AND ESCALATORS, to please feel free to print and use this form in the performance of their work. Hopefully it will prove as useful to you as it has for us.

By downloading or use of the documents included below, agreement to the terms and conditions for use are accepted by the user.

 View and/or Print the A17.1-2013 Periodic Test Witness Forms

 View and/or Print the A17.1-2016 Periodic Test Witness Forms

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