Underwriters Laboratories

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1. Basic Details 2. Product Details 3. Inspection Details 4. Contact & Billing Details 5. Confirmation
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DATE & REASON FOR INSPECTION
Please complete this form by answering all question thoroughly and in the requested format so that we may process with your Field Inspection immediately after receiving your application. [ = Required Field ]


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Please provide the reason for the Field Inspection. Please be specific as possible and explain the cause (Product shipped without a label, Product Shipped with incorrect label information, label inadvertently removed in the field, product modified in the field to another model, Local Inspector is requesting a UL inspection, etc.)




YOUR DETAILS















Indicate whether you are (please check all that apply):

MANUFACTURER DETAILS






PRODUCT DETAILS
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Is the product involved a Fire Protection Device?




Please provide the following UL File Information:


Do the product(s) to be inspected fully comply with UL’s Follow-Up Service Procedure and any Standards or other binding requirements?


INSPECTION LOCATION
What is the complete name and address of where the inspection is to take place?






STATUS OF EQUIPMENT & LABELS
Will arrangements be made to power down all equipment prior to inspection?




Will the Manufacturer’s Representative assume responsibility for providing access to the equipment including the provision and operation of all tools and machinery?




Will the Manufacturer’s Representative assume all responsibility for the operation of any test equipment or other machinery associated with the inspection?




Will the manufacturer’s representative provide all of the Inspection, Measuring, and Test Equipment (IMTE) required as part of the UL Follow Up Services Procedure or used in the conduct of the inspection of the product to our Field Representative?




Are UL Labels on the product?




Can you provide UL labels to the UL representative or jobsite contact once authorized by UL?






JOBSITE CONTACT INFORMATION
What is the name and telephone number of the individual representing your company who will accompany our representative at the jobsite?




AUTHORITY HAVING JURISDICTION (AHJ)



BILLING DETAILS
The cost for the Field Inspection, including all administrative, travel and inspection time required to establish the job and complete the work, will be billed to the specific UL File involved. The invoice will be directed to the Subscriber associated with the file (the subscriber normally receives invoices for UL’s factory inspection work where the product was produced). If you are not the UL Applicant for the file or the Manufacturer of the product you must apply for a Field Evaluation. Please call 1-877-UL-HELPS and select option #2 from the menu to initiate a Field Evaluation.


SUBMISSION CONFIRMATION

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