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2. Creating an account or logging in to Form Center is optional and is not required to submit this form.
4. Business Name
6. Name
7. Email Address
9. Address
11. City
12. State
13. Zip Code
15. Phone Number
16. Fax Number
18. Do you have an elevator/escalator safety inspection program?

    1. Yes
    2. No

20. If your city does not have an elevator/escalator safety program, all the units in your city will become part of the new State program.

22. If you do have a current elevator/escalator safety inspection program:

24. Do you only do an initial inspection when installed?

    1. Yes
    2. No
26. Do you do annual inspections?

    1. Yes
    2. No

28. At the discretion of the State Fire Marshal’s Office, the new Elevator Safety Act allows cities and counties with comparable programs to opt out of the State program.

30. Will you be applying to opt out of the State program?

    1. Yes
    2. No
32. Will you be transferring your elevator/escalator inspection program to our office?

    1. Yes
    2. No
34. Comments
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36. 1. Receive an email copy of this form.
37. Email address

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38. Submit

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