505 Sixth Street, Suite 200, New Westminster, BC V3L 0E1 Toll free: 1-866-566-7233 Email: [email protected] Website: www.safetyauthority.ca Payment Card Industry Data Security Standards prevent the use of credit card information sent through email or fax. A Client Service Representative will contact you within three business days to complete any payment process required. Restricted Access and FEO Phase II Operation Tests Declaration General Note: The information on this form is collected to administer the provisions of the BC Safety Standards Act and section 26 of the Freedom of Information and Protection of Privacy Act. If you have questions about the collection, use, or disclosure of this information, contacts the Records, Information & Privacy Analyst at 1-866-566-7233. Date: Owner: Building Name: BCSA #: Address: Elevator Class: Passenger □ City: Number of Floors: Restricted Access & Fire Emergency Operation Tests Freight □ Yes Is Phase I manual recall operational? Are all car calls operational on Phase II regardless of restricted access operation? Licensed Elevator Contractor: Mechanics name: Signature: Date: Reviewed by: Signature: Date: Where there is a conflict between this Guideline and the Act and Regulations the regulations shall prevail. BCSA is working towards going paperless! Participate by signing up for email notifications. FRM-1366-01 (2015-06-16) No
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