Pickerings Lifts LTD | 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
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 fingerguards 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*

: Hours

Minutes

AM/PM
Upload Photos (optional)
Drop files here or

Max. file size: 4 MB, Max. files: 4.
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.

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
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 fingerguards 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*

: Hours

Minutes

AM/PM
Upload Photos (optional)
Drop files here or

Max. file size: 4 MB, Max. files: 4.
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.

Activation Type

Radar Distances

ESPE Safety Devices (If Fitted)

Swing Door ESPE Safety Sensors

Sliding Door ESPE Safety Sensors

Closing Energies

Drawing in / Crushing Protection

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

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

Signage Fitted

Escape System

Activation Type

Radar Distances

ESPE Safety Devices (If Fitted)

Swing Door ESPE Safety Sensors

Sliding Door ESPE Safety Sensors

Closing Energies

Drawing in / Crushing Protection

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

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

Signage Fitted

Escape System

Request your company's specific servicing form!