UL | Field Inspection Application

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1. Basic Details

2. Product Details

3. Inspection Details

4. Contact & Billing Details

5. Confirmation

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1. Basic Details

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 ]

Requested Date for Inspection: Date selector

<< click to select a date

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.)

Reason:

YOUR DETAILS
Company:
Contact Name:
Title:

Country:
Address:

City:
State/Province:

Postal Code:
Email:
Phone:
Fax:

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

Applicant for the UL File Manufacturer of Product Fire Door/Frame Distributor

2. Product Details

MANUFACTURER DETAILS
Manufacturer Name:

Country:
Address

City:
State/Province:

Zip/Postal Code:

PRODUCT DETAILS
Date of Manufacture/Installation: Date selector

<< click to select a date
What type of product is involved?
Is the product a fire door/frame?
Yes No

How many units?

Is the product involved a Fire Protection Device?
Yes No

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?

Yes No

3. Inspection Details

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

Country:
Location Name:
Address:

City:
State:

ZIP/Postal Code:

STATUS OF EQUIPMENT & LABELS
Will arrangements be made to power down all equipment prior to inspection?
Yes No

Will the Manufacturer’s Representative assume responsibility for providing access to the equipment including the provision and operation of all tools and machinery?
Yes No

Will the Manufacturer’s Representative assume all responsibility for the operation of any test equipment or other machinery associated with the inspection?
Yes No

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?
Yes No

Are UL Labels on the product?
Yes No

Can you provide UL labels to the UL representative or jobsite contact once authorized by UL?
Yes No

4. Contact & Billing Details

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

Name:
Telephone Number:
Cell Number:
Email:

AUTHORITY HAVING JURISDICTION (AHJ)
Typically this will be the Local City,County or State Building Inspector, Fire Marshall or Electrical Inspector over the final installation site.

Name:
Telephone Number:
Email:
Title:

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.

5. Confirmation

SUBMISSION CONFIRMATION

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