Form Oes 7016R PDF Details

In the bustling metropolis of Miami-Dade County, the maintenance and safety of elevators, escalators, and moving walks are paramount for the safe transit of its residents and visitors. Within this framework, the OES-7016R form plays a critical role, serving as a mandatory accident report that owners of such equipment must submit following any incident. This requirement, enforced by the Office of Elevator Safety, underlines the county's commitment to delivering excellence every day by ensuring that all accidents are promptly reported, analyzed, and addressed to prevent future occurrences. Beyond mere compliance, the form details essential information about the accident, including the location, equipment involved, maintenance status, accident specifics, and immediate aftermath. Significantly, the document is designed not to assign blame but to gather data for improving safety standards. Failure to submit this report within the stipulated five-day period can result in substantial penalties, up to $1,000, emphasizing the gravity with which Miami-Dade County regards these reports. By mandating the submission of the OES-7016R form, the county aims to foster a safer environment for all who rely on its mechanical means of vertical and horizontal transportation.

QuestionAnswer
Form NameForm Oes 7016R
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescertificate of occupancy miami, certificate of occupancy miami dade, Flagler, yyyy

Form Preview Example

OES-7016R–

Miami-Dade County - Office of Elevator Safety Elevator/Escalator/Moving Walk Owners Accident Report

MIAMI-DADE COUNTY

INTERNAL SERVICES DEPARTMENT

FACILITIES and UTILITIES MANAGEMENT DIVISION

OFFICE of ELEVATOR SAFETY

 

 

 

201 West Flagler Street

 

 

 

 

 

 

Miami, FL 33130-1510



Ph: 305.375.1577

FAX: 305.372.6367

 

 

 

www.miamidade.gov

399.125 Reporting of elevator accidents; penalties.--Within 5 working days after any accident occurring in or upon any elevator, the certificate of operation holder shall report the accident to the division on a form prescribed by the division. Failure to timely file this report is a violation of this chapter and will subject the certificate of operation holder to an administrative fine, to be imposed by the

division, in an amount not to exceed $1,000. Within Miami-Dade County, accidents are to be reported to Miami-Dade County on this form

SECTION 1 – EQUIPMENT LOCATION

 

Serial

 

 

 

 

Elevator

 

 

 

 

Moving Walkway

Accident Date

 

 

 

 

 

 

 

 

(mm/dd/yyyy)

 

 

 

Number

 

 

 

Escalator

 

 

 

 

Wheelchair Lift

Time of Accident Hour

 

 

Minute

 

 

AM

PM

 

 

Owner Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Building Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County

 

 

 

 

 

 

 

State

 

 

 

 

Zip Code

 

 

 

 

 

Phone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 2 - SERVICE MAINTENANCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is the elevator or escalator under a service maintenance contract?

 

Yes

 

No

 

 

Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Elevator Maintenance Company

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Was the elevator service maintenance company notified?

Most recent required test performed?

Test Date

 

 

 

 

If yes, indicate date (MM/DD/YYYY)

 

 

 

 

6

 

1

 

 

 

 

3

 

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

months year

 

years

 

years

 

(mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 3 – ACCIDENT DETAILS

 

 

 

 

 

 

 

 

 

 

 

 

 

Brief Narrative: (attach additional sheets as necessary)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLEASE CHECK ALL THAT APPLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medical Attention

 

 

Fall

 

Bruises

 

Entrapment

 

Hand

 

 

Fingers

 

Hair

 

Other

 

 

 

Req’d

Y

N

 

 

Trip

 

Cuts

 

 

 

Arm

 

 

 

 

Leg

 

 

Knee

 

 

Foot

 

Toes

 

 

Torso

 

 

Other Factors:

 

Carryon Items/Packages

 

 

Stroller

 

Safety Issues

Mechanical

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Clothing/Footwear Involved:

Sleeves

Purse

 

 

Shoes

Dress/skirt

 

Pants

Coat

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Equipment Involved:

 

Door Open

 

 

Step–Stair Tread

 

Floor Leveling

 

 

Esc. Side Wall

 

Esc. Railing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Witnessed Activities:

 

Unsafe Rider Behavior

 

 

Equipment Malfunction

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Post Event Inspection Req’d

Y

 

 

N

 

Performed by:

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Optional) Unit Cleared for Continued Use:

 

Y

N

 

Cleared By:

 

 

 

CEI #

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 4 – REPORTING SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

Report Submitted by

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

 

Current Certificate ?

 

 

(print name)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

N

NA

 

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone Number

 

 

 

 

 

 

Contracted

Jurisdiction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disclaimer: This report is not intended to ascertain fault or to establish liability. The statutorily required completion enables the County to capture data for trending and analysis to improve rider safety. The report must be returned to the Office of Elevator Safety within 5 days of the accident to:

 

Miami-Dade County

 

 

ISD/Facilities and Utilities Management Div, Office of Elevator Safety,

 

201 West Flagler Street

 

 

24 Hr. Accident Tel. # 305-375-1555 Miami, FL 33130-1510

FAX: 305-372-6367

2012 JUL 16

Revised Form OES- 7016R

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Flagler conclusion process explained (stage 1)

2. The subsequent part is to fill out the next few blank fields: SECTION ACCIDENT DETAILS, Brief Narrative attach additional, Medical Attention N Reqd Other, Fall Trip, Bruises Cuts, Entrapment Arm, Hand Leg, Carryon ItemsPackages, Stroller, Safety Issues, Fingers Knee, Hair Foot Mechanical, Other Toes Other, Torso, and ClothingFootwear Involved.

A way to fill out Flagler stage 2

Be very attentive when filling out Fingers Knee and SECTION ACCIDENT DETAILS, since this is the part in which many people make a few mistakes.

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