Elevator Safety Forms


Reporting Elevator Accidents

File Report Online – Online Services

DBPR’s new Online Services now allows elevator owners to file accident reports directly from their online account. You can also change address information, renew your license and maintain service maintenance contract information with the online service. Just go to Online Services above to create your account and maintain your license(s). You do not need to complete the form below if you file electronically using our online service.

Elevator Owners Accident Report Form – Word / Fill-in PDF

DBPR HR-7016, form required to be filed in instances of elevator accident within 5 days of the incident. (October 14, 2009)

Fill in the accident report form in either Word or PDF format, save to your local drive, and send the completed form to the division by email to dhr.elevators@myfloridalicense.com or by mail to the address on the form.  You do not need to submit this form if you file the report electronically using our online service.

Consumer Complaints

File Complaint Online – Online Services

Consumer Complaint Form – Word / Fill-in PDF

DBPR HR 7003, form available to the public for making complaints concerning public food service establishments, public lodging establishments or elevators in Florida. (March 10, 2008)

License, Permit, and Registration Application Packets and Forms

For all classes of vertical conveyances, including elevators, escalators, moving walks, dumbwaiters, material lifts, chair lifts, etc. Also, for elevator professional licensing and continuing education registration.

Elevator Licenses, Permits and Professional Licenses –  APPLY

To apply for an elevator-related license online or obtain a paper application.

Continuing Education Course Provider Registration and Course Approval – Word / Fill-in PDF

DBPR Form HR 5023-017, application for registering as a continuing education provider and obtaining approval for a continuing education course. (March 25, 2014)

Petition for Variance from Rule – Word / Fill-in PDF

DBPR Form HR 5023-018, optional application for elevator hardship variances. For more information, see our Apply for Variance on our homepage. (October 14, 2010)

Verification of Service Maintenance Contract – Word / Fill-in PDF

DBPR Form HR 5023-060, optional form for submitting service maintenance contract annual verification, cancellation, or expiration. (July 9, 2013)

Inspection-Related Forms

Elevator Inspection Report Form (Industry Form) – PDF

DBPR Form HR 5023-003, is the approved conveyance inspection report used by Florida elevator inspectors completing paper inspection reports. See our inspection page for more information regarding inspection submitting inspection reports. (May 2016)

Scantron Scanner & Forms Store is the distributor of the elevator inspection report forms. DBPR Form HR 5023-003, Elevator Inspection Report, can be purchased from Scantron’s Internet store under specialty form number 283209.

Scantron sells the form in packages of 100 and requires payment by credit card. Inspectors must register as an individual account before completing a purchase.

Elevator Inspection Report Form (Bureau Form) – PDF

DBPR Form HR 5023-071, is the electronic conveyance inspection report used by the Bureau of Elevator Safety inspectors.  This draft blank form is provided as an example of the form completed by DBPR’s elevator inspectors.  Elevator licensees will be asked to sign the report and will receive a printed copy of the completed report.

Step-by-step Instructions for Completing the Elevator Inspection Report – PDF

DBPR Form HR 5023-055, is a detailed guide for filling out the Elevator Inspection Report, including tips on completing the bubbles on the scannable inspection report. (June 27, 2016)

Instructions for Completing the Elevator Inspection Report – PDF

DBPR Form HR 5023-053, is a quick reference for filling out the Elevator Inspection Report. (June 27, 2016)

Temporary Operating Permit/Temporary Certificate – PDF

DBPR Form HR 5023-005, is a sample of the required notice that must be posted on all Temporary Operation Inspection (TOI) elevators and all elevators with satisfactory initial acceptance inspections. The form is included with the Elevator Inspection Report Form, DBPR Form HR 5023-003. Instructions for use are included in the step-by-step instructions above.
(October 8, 2012)

Acceptance Inspection Procedure – PDF

DBPR Form HR 5023-052, is an instruction sheet for performing acceptance inspections. (February 10, 2014)

Disciplinary Citation and Stop Work Order – PDF

DBPR Form HR 5023-059 is a sample citation and stop work order that the division issues for unlicensed activity. (April 8, 2015)

Maintenance Control Program Checklist – PDF

DBPR Form HR 5023-072, is a checklist provided as general guidance outlining the minimum requirements for a maintenance control program under ASME A17.1-2013, as adopted by Rule 61C-5.001, Florida Administrative Code. This form is provided as guidance only. (November 2019)

Newsletter Elevator UPdate

Need Help?

All requests for public records, complaints, forms, and applications for licenses can be obtained by contacting the Customer Contact Center.

Steven von Bodungen, Director

Division of Hotels and Restaurants
Bureau of Elevator Safety
2601 Blair Stone Road
Tallahassee, FL 32399-1013

Telephone: 850.487.1395
Email: dhr.elevators@myfloridalicense.com