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 licensed by the fire marshal.

Form Completion Instructions
  1. Accuracy & Review: Carefully fill out the inspection form and review your entries for accuracy—paying close attention to Device Registration Number and Date Inspection Conducted—before proceeding.
  2. Certification: Review the formal certification statement at the bottom of the form. Check the Acknowledgment box to verify that you are submitting an official record to a governmental authority.
  3. Select Payment Option:
    • Proceed to Payment – Finalize payment immediately.
    • Add to Cart – Save this entry and view the cart.
    • Submit and Pay Later – Submit now and return to pay via the Pending Inspection Payments page later.

Device

Please enter information about the device being inspected.

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

Looks good!
Please enter the name of the stucture.
Verify Device
Looks good!
Please enter the device registration nummber.
Either the Annual or Five Year Load Test box must be checked before proceeding.
Looks good!
Please select the annual inspection or five year load test.
Looks good!
Please enter the date the inspection was conducted.

About This Device

Information retrieved for the selected device.

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.

Looks good!
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 40:1646 and LAC 55:V.Chapter 33I 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.
LAC 55:V.Chapter 33 La. R.S. 14:133 La. R. S. 40:1646