Registration Information (Confidential) Form/elevator Inspections
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1REGISTRATION INFORMATION (Confidential)
ELEVATOR INSPECTIONS
Community Services
PERSONNEL
RELATED EXPERIENCE
DESCRIPTION
EMPLOYMENT
(if directly involved in contracting)
OF
BACKGROUND
BACKGROUND
President
MANAGEMENT
PROFESSIONAL
ENGINEER’S
General Manager
WORKING
SUPERVISORS
OFFICE
Service Manager
MECHANICS
HELPERS
Construction Manager
WELDER’S
(Certified)
OTHERS
TOTAL EMPLOYEES
MINIMUM EMPLOYMENT STANDARDS
TRAINING PROGRAM - HOURLY PAID
EXPENSES
Working Supervisor
(on and off the job - safety and job skills)
Mechanic
Helper
WORKLOAD (Past 12 months)
Type of Work Preferred
Standards
New
Type of
Manufacturing
Installing
Maintaining
Signify knowledge and
Installations
Maintenance
understandig of standards
Started
(as applicable, in whole or in
part:
Major
Alterations
Started
Service
Number of
Number of
Elevators
Elevator &
(Approx #)
Contracts
Installations
Fixed
Conveyance
Act & Regs Yukon
Full Main.
Dumbwaiters
Canadian
Electrical Code
Section 38
P. O. G. Cont.
Escalators
CSA 844
Code
I & R Cont.
Manlifts
CSA Z185
2256
Other Cont.
Amusement
CSA ZB355
Rides
SUBMIT BLANK SPECIMEN CONTRACTS
Handicapped
CSA Z267
Lifts
Passenger
CSA W59
Ropeways
Lifts
CSA Z98
WE CERTIFY THAT THE INSTALLATION, MAINTENANCE AND REPAIR OF ALL PARTS OF THE EQUIPMENT WILL CONFORM WITH THE
REQUIREMENTS OF THE ELEVATOR AND FIXED CONVEYANCES ACT AND REGULATIONS, YUKON TERRITORY.
SIGNATURE:
Name: _______________________________
(Pres. or Officer) _______________________________________ Date: _________________________
company representatives will be interviewed at a panel review board.
Phone: _____________________ Title: ____________________________
DO NOT COMPLETE BELOW THIS LINE
-
FOR OFFICE USE ONLY
New Registration
First Registered
REVIEWS (PAST 24 MONTHS)
NOTES:
________
________/________/________
Previously
Registered _______
CURRENT
REGISTRATION
TYPE OF EQUIPMENT
MANUF
INSTALL
MAINT
ELEVATORS
REGISTRATION HISTORY
DUMBWAITERS
ESCALATORS
MANLIFTS
AMUSEMENT RIDES
HANDICAPPED LIFTS
PASSENGER
ROPEWAYS
YG(5426Q)F1 04/2011
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