Elevator Maintenance Authorization Form

Except as permitted herein or by the Division of Elevator Safety, after April 30, 2009, no Contractor, Mechanic or Inspector may work on or inspect a conveyance that has not registered with the State of Illinois.

Should a situation occur where a licensee has been contacted to remove a trapped or injured person from a conveyance or render the conveyance out of service for reasons of safety, the licensee may perform such work, but must notify the Division of Elevator Safety within 1 business day of the action.

For other situations that do not impose an immediate threat of harm, approval from the Division of Elevator Safety should be received in advance of such work.

Please complete the attached form and submit to the Elevator Safety Division. Notification of approval/denial will be given within 24 hours of submission to the Location Contact Email Address.

Conveyance Owner Information

Please include the owner's name.
Name:
Please include the owner's address.
Address:
Please include the owner's city.
City:
Please include the owner's state.
State:
Please include the owner's zip code.
Zip:
Telephone:

Location Contact Information

Please include the contact's name.
Name:
Address:
City:
State:
Zip:
Telephone:
Email:
# of Conveyances:

Mechanic Information

Name:
License Number:

Request Information

Need For Request:
Other/Comments:

Approval is good for 30 days from the date of the approval. Conveyance MUST be registered by expiration date. Applications for Registration of Conveyance may be found on our website.

Version 1.1