Contractors must submit this form prior to each installation or alteration of elevators, dumbwaiters, escalators, moving walks, workman’s hoists, material hoists, man lifts, moving walks, and stage or orchestra lifts, as defined in the Arizona Elevator Act, A.R.S. Title 23, Chapter 2, Article 12.

This form must be completed in its entirety.  Failure to do so may cause a delay in processing. It can be submitted online or it can be submitted to ADOSH by mail, fax, or hand-delivery.

For additional information or assistance you may contact the ADOSH Elevator Section directly at 602-542-3313 or ADOSH toll-free at (855) 268-5251.

Arizona law permits workers’ compensation claimants and their attorneys to file a petition, prior to a final disposition of the case, requesting that the Commission set reasonable attorney’s fees related to a workers’ compensation claim. See A.R.S. § 23-1069.  Claimants or their attorneys may use this form to request that the Commission set fees.  Please provide the information requested and attach any supporting documents. Failure to provide all requested information may delay processing.

Please submit a Petition for Attorney’s Fees Pursuant to A.R.S. § 23-1069 via the online form link below.:

The injured worker and treating physician will be instructed to complete this form while the injured worker is on a no work status. It must be completed in its entirety. 

IMPORTANT:  Any person who knowingly makes a false statement or representation to obtain any compensation, benefit or payment is guilty of a class 6 felony and is subject to up to one and one-half years in prison, a fifty thousand dollar fine and forfeiture of benefits.

This form may be used to request a hearing. It must be completed in its entirety including the reason for the request. The request for a hearing should indicate which notice, award, or order is being protested and the grounds on which the hearing is requested.  Failure to state the reason for the request may cause a delay in processing.  

This form is not used as a Request for Investigation pursuant to A.R.S. § 23-1061(J).  For a Request for Investigation, this form must be used: - Request For Investigation Form -

Information about the Industrial Commission of Arizona’s claims and hearing process including applicable laws and rules are available at the Industrial Commission offices and the ICA website:  www.azica.gov.

The following provisions must be met or the request will not be accepted:

1. The boiler or fired pressure vessel must be constructed in a manner which meets the standards of the Arizona Administrative Code, Boiler Rules: R20-5-404.
2. The owner, user or licensed contractor shall have on-site the Manufacturer's Data Report for the boiler and/or fired pressure vessel, and any other Manufacturer's manuals/documents pertinent to the contemplated alteration or repair.
3. Non-weld alterations or repairs shall be performed by an installer holding a current contractor's license issued pursuant to Chapter 10, Title 32, A.R.S. §32-1122, which authorizes the licensee to perform boiler or fired pressure vessel work.
4. This Inspection Request is not for welded alterations or repairs. Alteration or repair of a boiler or fired pressure vessel involving welding shall be performed by an organization accredited by the National Board of Boiler and Pressure Vessel Inspectors as stipulated in A.A.C. R20-5-404B.

This form must be completed in its entirety.  Failure to do so may cause a delay in processing. It can be submitted online or it can be submitted to ADOSH by mail, fax, or hand-delivery.

This form must be submitted by the 5th Business Day from the cleared date of the ACH Payment. Once completed, email the form to the GAO AFIS Operations Group at: [email protected].