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STATE OF FLORIDA ELEVATOR INSPECTION REPORT

Inspection Date

Certified Elevator Inspector (CEI)#

Type of Inspection

Routine
Alteration Acceptance
Callback
Construction
Initial Acceptance
Temporary Operating Inspection

DBPR Use Only

Accident
Complaint
Compliance Monitoring
Industry Oversight/Audit

Time In

Time Out

Inspection Company Name

REC #

Building Name

Building Address

Address Line 1

City

State

Zip Code

Serial Number

DEFINITIONS

CEI - FL Certified Elevator Inspector
CET - FL Certified Elevator Technician
REC - FL Registered Elevator Company

SUPERVISOR OF CONSTRUCTION

I certify that as the elevator company supervisor, I directly supervised the construction or installation of this elevator.

Signature

Clear Signature

CEI #

CET #

Print Name

Phone Number

Click Here to download a list of violation codes (PDF)

Violation 1

Violation 2

Violation 3

Violation 4

Violation 5

Violation 6

Violation 7

Violation 8

Comments and Brief Description with Code Citation

PERSON RECEIVING THIS REPORT

If violations are cited, this report constitutes an Order to Correct as outlined in s. 399.061(4), Florida Statutes. Violations must be corrected within 90 days in accordance with s. 399.105(4), Florida Statutes.

Pass
Fail

Signature

Clear Signature

Title

Print Name

Phone Number

CERTIFIED ELEVATOR INSPECTOR

I certify that I have personally performed or witnessed:

Routine inspection
Periodic tests as prescribed by ASME A17.1
Acceptance inspection of new or altered installation as recommended by the ASME A17.2 Inspectors Manual
Violations cited on the previous inspection report have been corrected.
Installation meets or exceeds minimum standards of Chapter 399, Florida Statutes, and Chapter 30 of the Florida Building Code adopted by Rule 9B-3.047, Florida Administrative Code.

This device

Complies With
Does Not Comply With
Is Exempt From

Section 399.15, Florida Statutes: Regional emergency elevator access/fire key requirements.

Signature

Clear Signature

CEI #

Print Name

Phone Number

Notice to Certified Elevator Inspector
Completed inspection report must be submitted to the Bureau of Elevator Safety within five (5) working days of inspection.

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