Automated Gate Safety Review Form (Online Version)
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Please use one form for each gate system, completing all appropriate fields, those with red asterisks are mandatory.
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| Date of Completing this Form
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| Please note: The date format is Month/Day/Year
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| Your Reference Number (if applicable)
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| Your reference number can be found on your gate system control box
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| System Location:
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| Please describe the precise location of your system.
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| Name
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| Prefix
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| First
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| Last
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| Suffix
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| Site Address
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| NOTE: Please enter your County in the State/Province/Region field.
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| Street Address
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| Address Line 2
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| City
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| State / Province / Region
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| Postal / Zip Code
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| Country
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| Phone Number
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| Email Address
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Section 1.0 - Potential for Personal Injury
Please select appropriate answer(s) below.
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1.1 - Are pedestrians expected to use the system as a means of access?
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| YES NO
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1.2 - Is there an alternative access point, for example a manual or side gate?
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| YES NO
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1.3 - If YES, where is the alternative access point located?
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| ADJACENT CLOSE BY SET AWAY
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1.4 - Are vulnerable persons or children likely to use or play near the system?
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| YES NO MAYBE
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1.5 - What is the likelyhood of personal injury from the system when opening and closing?
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| LIKELEY UNLIKELY UNSURE
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1.6 - How serious would any personal injury be from the system when opening and closing?
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| MINOR MAJOR UNSURE
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1.7 - Is personal injury likely to occur during the following cycles?
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| OPENING CLOSING BOTH
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1.8 - Is personal injury likely to occur from these locations?
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| HINGED END SWING END POST PIER OTHER ALL
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| 1.9 - Are the pinch points and trap areas as safe as is reasonably possible?
| YES NO UNSURE
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Section 1.0 - (Continued)
1.10 - Force Settings Test
Considering the environmental changes likely to effect the gate system (snow & ice in winter, high winds & hot summer days), are the operational pressure settings for the gate(s) suitable, in both directions, without excessive load?
SAFETY FIRST: Take great care if testing, please do not hold or block the gate personally. If you require further guidance please contact our office on 0845 094 6070.
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1.11 - Following the force settings guidance above, carry out the test and then submit your answer to the question.
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| YES NO UNSURE
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| 1.12 - When activated, how do the safety devices work? Select A, B or C.
| A - The Gate stops B - The Gate stops and returns in one direction only. C - The Gate stops and returns in either direction.
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Section 2.0 - Vehicular Protection
Please select appropriate answer(s) below.
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| 2.1 - Please indicate the safety device(s) fitted to the system.
| NONE INSTALLED PHOTO-SWITCHES INDUCTION LOOP SAFETY EDGE OTHER (Please specify)
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If "OTHER" has been checked:
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| 2.2 - Are functional safety photo-switches installed, if so where?
| NONE INSTALLED BETWEEN GATE POSTS INSIDE OPERATING AREA OUTSIDE OPERATING AREA
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| 2.3 - How many safety photo-switches are fitted?
| SINGLE UNIT ONE PAIR TWO PAIRS MORE (Specify)
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If "MORE" has been checked:
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2.4 - Are functional induction loops installed, if so where?
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| OUTSIDE OF GATE INSIDE OF GATE INSIDE & OUTSIDE UNDER GATE
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| 2.5 - How many functional induction loops are fitted?
| ONE TWO THREE MORE (Specify)
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If "MORE" has been checked:
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2.6 - Are there functional safety edges installed?
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| YES NO
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| 2.7 - How many functional safety edges are fitted?
| ONE TWO THREE MORE (Specify)
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If "MORE" has been checked:
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| 2.8 - Where are the functional safety edges installed?
| ON THE GATE ON THE GATE POST ON THE WALL ON A BEAM OTHER (Specify)
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If "OTHER" has been checked:
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Section 3.0 - General Information
Please select appropriate answer(s) below.
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| 3.1 - Which of the following is the system serving?
| SINGLE HOME OR OFFICE MULTIPLE HOMES OR OFFICES COMMERCIAL OR PUBLIC PROPERTY OTHER (Please Specify Below)
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If "OTHER" has been checked:
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3.2 - What type of gate or barrier do you have?
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| SWING SLIDING LIFT RISING
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| 3.3 - How many users is the system allowing through each day?
| UP TO 20 USERS UP TO 60 USERS UP TO 100 USERS MORE (Specify)
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If "MORE" has been checked:
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Image Upload Facility
If beneficial to do so, we invite you to support this report with images of your gate system, a maximum of six may be uploaded, one per upload box below.
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| Image 1 of 6
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| Image 2 of 6
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| Image 3 of 6
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| Image 4 of 6
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| Image 5 of 6
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| Image 6 of 6
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Copyright: Gate-A-Mation Ltd - Version 1.0 - July 2010
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Image Verification
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