Accident Report Forms

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.

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)

File a complaint using DBPR Online Services

Application Packets and Forms

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

This page contains helpful information about elevators. To apply for an elevator-related license using a paper application, please click this APPLY link.

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 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)

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)

Inspection 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)

Tips for Completing Scannable Inspection Reports

See page four (4) of DBPR Form HR 5023-055, Step-by-step Instructions for Completing the Elevator Inspection Report, for tips on completing the bubbles on the scannable inspection report.

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 ProcedurePDF

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

Maintenance Control Program Checklist – Fill-in 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. (December 31, 2017)

NewsletterElevator UPdate

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

DBPR Form HR 5023-018, optional form for submitting a petition for variance from a rule.

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)

Need Help?

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

Rick Akin, 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