Safety Brush Order & Survey Form

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Job Site Survey

Building Name:

Make Of Escalator:
Escalator Model:
Measured Escalator Length:
(Measured from comb tip to comb tip & with survey instructions)

Unit Description:(Eg:1-2 Up)            sq.gif (857 bytes) Up         sq.gif (857 bytes) Down

sq.gif (857 bytes)  Job Site Address Same As Shipping Address
Job Site Address:
Authority Having Jurisdiction:
Code Observed:  sq.gif (857 bytes)  A17, sq.gif (857 bytes)  B44, Other
Floor#                                      Unit#
Skirt construction:
sq.gif (857 bytes)  Stamped Stainless Skirt
sq.gif (857 bytes)  Stainless Over Wood Skirt
sq.gif (857 bytes)  Extruded Aluminum Skirt
sq.gif (857 bytes)  Other

Skirt Finish:
sq.gif (857 bytes)  Silver
sq.gif (857 bytes)  Black
sq.gif (857 bytes)  Other

Choose the drawing that best matches your skirt design:

Dimension A (mounting window):

Dimension B (skirt thickness):

Draw Your Own                                     


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please fill out first page

Quality Elevator Products Inc. • 7760 Merrimac Ave. • Niles • IL 60714 • (847) 581-0085 • Fax: (847) 581-0095 •