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:

  • All online applications are processed by our Call Center during our office hours.
  • Our office hours are Monday to Friday, 7:30AM – 4:30PM Eastern Time. Please note: forms received after 2:00PM may not be processed until the next business day.
  • Scheduling is arranged by the inspector. Our inspectors make it their priority to contact you within 2 business days from the day your submitted application form was processed.
  • If your request is of an urgent nature, please call us at 1-800-559-5356 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.
  • For Field Evaluation Inspections in Northern Ontario, please contact our Customer Service Centre at 1-800-559-5356.
  • Not interested in filling out the web version? Our application is also available in print PDF format. You can download the print version here Application-form.pdf


Payment Information

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

Submitter Billing Information

Equipment Inspection Location

Same as Billing Address

Preferred Inspection Date

Type of Inspection and Label Requested

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

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Submittal

Our terms and conditions are available at the following link: http://www.esafieldevaluation.ca/Resources/TermsBil.docx.

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 ESA the authority to invoice the Submitter

Submitter Representative

FE-APM#13W Rev. 0 April 26, 2017