PJ Automation – ADIA Service Form

Whats the purpose of your visit?*

Site Address

Street Address Address Line 2 City County Post Code

What is the Location / Reference for the door?*

Door Type?*

Door Opening Width

Enter in mm

Opening Time

Enter in seconds

Hold Open Time

Enter in seconds

Closing Time

Enter in seconds

Activation Type

Radars
Push Pads
Access Control
Fire Alarm
Other

How many Radar Sensors?

How many Push Pads?

Is there Access Control?*

Is there a fire alarm connected?*

Other Activation Type

Radar Distances

Radar Inner / Direction of escape

Enter in mm

Radar Outer / Opposite Direction

Enter in mm

ESPE Safety Devices (If Fitted)

Overhead Quantity

Door Mounted Quantity

Swing Door ESPE Safety Sensors

Closing direction test box detected

Opening direction test box detected

Sliding Door ESPE Safety Sensors

Threshold test box detected

Side screen(s) test box detected

Closing Energies

Dynamic forces (Newtons)

Drawing in / Crushing Protection

Are fingerboards fitted?

Are barrier rails fitted?

Are pocket doors fitted?

Sliding Doors - Distances to Prevent Drawing in / Crushing / Shearing

Leaf to Frame / Structure

enter in mm

Opposing closing edge

enter in mm

Swing Doors - Distances to Prevent Drawing in / Crushing / Shearing

Open door to barrier

enter in mm

Open door to return wall

enter in mm

Signage Fitted

Please enter quantity of signage fitted

Automatic Door Sign

Please enter quantity

Keep Clear Sign

Please enter quantity

Disabled Sign

Please enter quantity

Push button to operate sign

Please enter quantity

Breakout Pictogram

Please enter quantity

Escape System

Is Breakout Fitted?

Force Required to Breakout

Please enter in Newtons

Force to open the door manually after power failure

Please enter in Newtons

Is a fail safe fitted?

Fail type?

System tested

System working

Defects, Risks or Hazards

Is the system compliant with BS EN16005?

The door is in working order but requires repairs/modifications to reduce risk of personal injury

Yes

The door presents an unacceptable personal injury risk and has been set to a safe position

Yes

Technician*

Technician Signature*

Date*

Time*

: HH

MM

Upload Photos (optional)

Drop files here or

You can upload photos of the door or components here

Note: This checklist must be retained by the specifier or building owner for record purposes in accordance with ‘British Standard 7036- 0, EN16005’. A copy will be retained by the authorised technician. All automatic doors must be serviced by the authorised technician at least annually as per BS 7036-0, EN16005.