ESAFE - Inspection Form

ONLINE APPLICATION FOR ESAFE INSPECTION

Welcome to the online application form. Here you can request a Field Evaluation inspection. Before completing and sending this form, there are a few things you should keep in mind:

Cross border travel is subject to various restrictions on account of COVID-19. We will do our best to accommodate your requests and will work with you to address any travel challenges through all possible options.
All online applications are processed by our Customer Service Center during our office hours.
Our office hours are Monday to Friday, 7:30AM – 4:00PM Eastern Time. Please note: forms received after 2:00PM may not be processed until the next business day.
Scheduling of inspections is done by our inspectors and they will make every effort to accommodate your preferred inspection date. If you have not been contacted by your inspector within 2 business days please reach out to them directly at the phone number and/or email listed on your Application Confirmation.
If your request is of an urgent nature, please call us at 1-800-559-5356 (CAN/US) or 1-613-271-1489 and speak to a representative.
This application form does NOT apply to the Certification of products (e.g. Hazardous Locations). For Hazardous Locations or other product Certification, please contact us.
Please note no third party billing.

Payment Information

PO # :

ESA Account # :

If you do not have an existing Account Number, we may contact you to obtain credit card information:

Submitter Billing Information

Company Name:*

Invoice Attn to:*

Address:*

City:*

Province / State:*

Postal / Zip Code:*

Phone:*

Email:*

Equipment Inspection Location

Same as Billing Address

Site Name:

Area / Room:

Contact Name:

Address:*

City:*

Province / State:*

Postal / Zip Code:*

Phone:*

Email:

Preferred Inspection Date

Date Ready: ?

Type of Inspection and Label Requested

Note: An additional charge is applicable for inspections involving the TUV label. For more information on our labels, view our Product Approvals.

ESAFE (CSA SPE-1000 for Canada)
S Series

TUV (For U.S.A.)

Other

1: Equipment Name (Description max. 30 characters):*

Manufacturer:

Serial #:

Model #:*

Quantity:

Add

Notes / Special Instructions for the Inspector:

Upload Attachments (Up to 5):

Click to Select a File

Submittal

Our terms and conditions are available at the following link: http://www.esafe.org/files/FE-APM13T1-TermsBIl-Rev12-2023-04-20.pdf.

I am confirming that:

I am an authorized representative for the Submitter, and
The Submitter has reviewed and agrees to be bound by the terms and conditions for this service, and
The Submitter gives ESAFE the authority to invoice the Submitter

Submitter Representative

Name:*

Title:*

Email:*

This is step one of a two-step process.

FE-APM#13W Rev. 2 April 14, 2022.

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Payment Information

Company Name:*
Address:*
Province:*
Phone:*

Invoice Attn:*
City:*
Postal Code:*
Email:*

Equipment Inspection Location

Site Name:
Site Contact Name:
Site Address:*
Site Province:*
Site Contact Phone:

Area / Room:

City:*
Postal Code:*
Site Contact Email:

Submitter Representative

Submitter Name:*
Submitter Title:*
Submitter Email:*

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ESAFE COVID-19

Customer Screening Notice
The safety of our employees, supplier partners, customers, and families remain ESAFE’s overriding priority. As the COVID-19 pandemic continues to evolve, ESAFE’s Health and Safety department is monitoring the situation closely and will periodically update company guidance based on current recommendations from the Centers for Disease Control and Prevention, the World Health Organization and Public Health guidelines.

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our workforce, we are conducting a simple screening before our inspector schedules a visit to your site. Your participation is important to help us take precautionary measures to protect our inspector, you and everyone at your facility.

Thank you for your time.

*Mandatory Fields

To your knowledge, has anyone at the Equipment Inspection Location been diagnosed as having COVID-19 in the past 14 days?*

To your knowledge, has anyone at the Equipment Inspection Location returned from a trip outside Canada within the past 14 days and have had to quarantine as per federal regulations?*

To your knowledge, has anyone at the Equipment Inspection Location had close contact with someone diagnosed with COVID-19 within the last 14 days?*

Our Inspector will be following standard protocols with regards to COVID-19 safety (such as wearing a mask, sanitizing hands, and maintaining 6 feet of distance from other persons). Please identify any additional instructions (including rules for additional special PPE) related to COVID-19 safety that you require our Inspector to follow during the Inspection.

If your answer to any one of the first 3 questions is “yes", your ESAFE Inspector may contact you to obtain further information prior to scheduling the site visit.

Questions? Call us at 1-800-559-5356, or email us at field.evaluation@esafe.org and we will be pleased to assist you.

ONLINE APPLICATION FOR ESAFE INSPECTION

Payment Information

Submitter Billing Information

Equipment Inspection Location

Preferred Inspection Date

Type of Inspection and Label Requested

TUV Information

Submittal

Submitter Representative

Payment Information

Equipment Inspection Location

Submitter Representative

ESAFE COVID-19