Conveyance Device Inspection Form

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Legislative Mandate

R.S. 40:1646.(B)(3)

The owner of any building containing a conveyance device shall cause at a minimum an annual inspection and certification, to be physically witnessed by an inspector appointed by the fire marshal.

Device

Please enter information about the device being inspected.

If there’s an asterisk we have to get that information.

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Please enter the name of the stucture.
Verify Device
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Please enter the device registration nummber.

Address

Structure Address

City

Rating

Rate Load (lb or kg)

Speed (ft/min or m/s)

Credentials

Please enter information for the inspector and inspection firm.

If there’s an asterisk we have to get that information.

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Please enter the inspection firm's OSFM license number.
Looks good!
Please enter the inspector's OSFM license number.

Acknowledgment

I acknowledge, certify, and affirm that this conveyance device has been inspected and has successfully passed all inspections required under the authority of the Louisiana Revised Statutes, Title 33 (La. R.S. Title 33). I understand that this acknowledgment constitutes a formal certification submitted to a governmental authority. I further understand that knowingly making a false, misleading, or inaccurate certification may constitute the filing of false public records pursuant to La. R.S. 14:133 and may subject me to criminal penalties, including fines, imprisonment, administrative enforcement actions, and the revocation or denial of any associated permits, licenses, or approvals.
La. R.S. 33 La. R.S. 14:133