Elevator Safety – Forms

Reporting Elevator Accidents

File Report Online – DBPR 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 DBPR 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 – Fill-in PDF

DBPR HR-7016, form required to be filed in instances of elevator accident within 5 days of the incident. Send the completed form to the division by email @ dhr.elevators@myfloridalicense.com.  You do not need to submit this form if you file the report electronically using our online service.

Consumer Complaints

File Complaint Online – DBPR Online Services

Consumer Complaint Form – 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.

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.

Affidavit Verifying Elevator Work History for Certificate of Competency Applicants – Word / PDF

DBPR HR-5023-076 form is an affidavit that once completed by a registered elevator company meets requirements for proof of four years experience constructing, maintaining, servicing, or repairing elevators or other conveyances regulated by the division. Verification of work experience is required for the Certificate of Competency credential.

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.

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.

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.

Placing Your Elevator in Seal/Inactive Status – What You Need to Know – PDF

Guidance for operators with an elevator that is not in use.

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. (

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.

Instructions for Completing the Elevator Inspection Report – PDF

DBPR Form HR 5023-053, is a quick reference for filling out the Elevator 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.

Acceptance Inspection Procedure – PDF

DBPR Form HR 5023-052, is an instruction sheet for performing acceptance inspections.

Notice of Initial Acceptance Inspection

Permit holders are required to notify the division of the date and time of initial acceptance inspections at least five days prior to its occurrence.  To make this process easy, please use the web form below.  If the inspection is rescheduled, the permit holder should notify the division as soon as the new date and time are determined using this same form.

Notice of Initial Acceptance Inspection

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.

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.

Newsletter – Elevator Update