Form UCC-F326 "Ucc Elevator Devices - Accident/Incident Report" - New Jersey

What Is Form UCC-F326?

This is a legal form that was released by the New Jersey Department of Community Affairs - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2008;
  • The latest edition provided by the New Jersey Department of Community Affairs;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form UCC-F326 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Community Affairs.

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Download Form UCC-F326 "Ucc Elevator Devices - Accident/Incident Report" - New Jersey

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UCC ELEVATOR DEVICES - ACCIDENT/INCIDENT REPORT
MUNICIPALITY:
DATE OF ACCIDENT:
Date when accident is reported to municipality:
Accident reported by:
Name:
Telephone #:
Address:
Building Address:
Registration #:
Building
Use:
Inspection Cycle:
ID:
Type:
Device:
Owner:
Name:
ADDRESS
CITY
STATE
ZIP CODE
Name(s) of the injured:
Accident resulted in:
Injury:
Death:
Last inspection prior to accident:
Date:
Type:
Performed By:
License Number
Name
Were violations cited:
YES
NO
Attach a copy of the latest inspection report prior to the accident and a copy of the list of violations when cited.
Latest certificate granted: Type:
Date Issued:
Expiration Date:
List of Codes; Reference Standards the device shall be in compliance with:
Device Data: Capacity:
Speed:
# of Floors Served:
Operation(s):
Machine type:
Door type: Hoistway
Car
Device Under Maintenance Contract: YES
NO
If yes, name of maintenance company:
NOTE:
U.C.C F310 form shall be used to record S/U conditions and violations found during a special
inspection.
Construction Official:
Name
Signature
Report prepared by:
Name
Signature
U.C.C. F326
(rev. 6/08)
UCC ELEVATOR DEVICES - ACCIDENT/INCIDENT REPORT
MUNICIPALITY:
DATE OF ACCIDENT:
Date when accident is reported to municipality:
Accident reported by:
Name:
Telephone #:
Address:
Building Address:
Registration #:
Building
Use:
Inspection Cycle:
ID:
Type:
Device:
Owner:
Name:
ADDRESS
CITY
STATE
ZIP CODE
Name(s) of the injured:
Accident resulted in:
Injury:
Death:
Last inspection prior to accident:
Date:
Type:
Performed By:
License Number
Name
Were violations cited:
YES
NO
Attach a copy of the latest inspection report prior to the accident and a copy of the list of violations when cited.
Latest certificate granted: Type:
Date Issued:
Expiration Date:
List of Codes; Reference Standards the device shall be in compliance with:
Device Data: Capacity:
Speed:
# of Floors Served:
Operation(s):
Machine type:
Door type: Hoistway
Car
Device Under Maintenance Contract: YES
NO
If yes, name of maintenance company:
NOTE:
U.C.C F310 form shall be used to record S/U conditions and violations found during a special
inspection.
Construction Official:
Name
Signature
Report prepared by:
Name
Signature
U.C.C. F326
(rev. 6/08)