Whats the purpose of your visit?*Please ChooseServiceCommissioningSite Address Street Address Address Line 2 City County Post Code What is the Location / Reference for the door?*Door Type?*Please ChooseSlidingSliding telescopicSliding curvedFoldingSwingLow Energy SwingBalancedDoor Opening WidthEnter in mmOpening TimeEnter in secondsHold Open TimeEnter in secondsClosing TimeEnter in secondsActivation TypeActivation Type Radars Push Pads Access Control Fire Alarm Other How many Radar Sensors?How many Push Pads?Is there Access Control?*Please ChooseYesNoIs there a fire alarm connected?*Please ChooseYesNoOther Activation TypeRadar DistancesRadar Inner / Direction of escapeEnter in mmRadar Outer / Opposite DirectionEnter in mmESPE Safety Devices (If Fitted)Overhead QuantityDoor Mounted QuantitySwing Door ESPE Safety SensorsClosing direction test box detectedPlease ChooseYesNoNot ApplicableOpening direction test box detectedPlease ChooseYesNoNot ApplicableSliding Door ESPE Safety SensorsThreshold test box detectedPlease ChooseYesNoNot ApplicableSide screen(s) test box detectedPlease ChooseYesNoNot ApplicableClosing EnergiesDynamic forces (Newtons)Please ChoosePassFailDrawing in / Crushing ProtectionAre fingerguards fitted?Please ChooseYesNoAre barrier rails fitted?Please ChooseYesNoAre pocket doors fitted?Please ChooseYesNoSliding Doors - Distances to Prevent Drawing in / Crushing / ShearingLeaf to Frame / Structureenter in mmOpposing closing edgeenter in mmSwing Doors - Distances to Prevent Drawing in / Crushing / ShearingOpen door to barrierenter in mmOpen door to return wallenter in mmSignage FittedPlease enter quantity of signage fittedAutomatic Door SignPlease enter quantityKeep Clear SignPlease enter quantityDisabled SignPlease enter quantityPush button to operate signPlease enter quantityBreakout PictogramPlease enter quantityEscape SystemIs Breakout Fitted?Please ChooseYesNoForce Required to BreakoutPlease enter in NewtonsForce to open the door manually after power failurePlease enter in NewtonsIs a fail safe fitted?Please ChooseYesNoFail type?Please ChooseOpenClosedSystem testedPlease ChooseYesNoSystem workingPlease ChooseYesNoDefects, Risks or HazardsIs the system compliant with BS EN16005?Please ChooseYesNoThe 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*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Time* : HH MM AM PM Upload Photos (optional) Drop files here or You can upload photos of the door or components hereNote: 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.