FORM No. 41

(Prescribed under Rule 72)

 Report of examination of hoists and lift

       Registration number                                        :

       Licence number                                              :

       NIC Code Number                                         :
(As given in the licence)                                  :

1.    Occupier (or owner) of premises                                   :

2.    Address                                                                       :

3.    (a) Type of hoist or lift and identification number           :
            or description

       (b) Date of construction or reconstruction
            (if ascertainable)

4.    Are all parts of the hoist or lift of good mechanical         :
       construction, sound material and adequate strength
       (so far as ascertainable)

5.    Are the following parts of the hoist or lift properly          :
       maintained and in good working order?

       If not, state what defects have been found

       (a) Enclosure of hoistway or liftway                               :

       (b) Landing gates and cage gare(s)                                 :

       (c) Interlock and the landing gates and cage gate(s)         :

       (d) Other gate fastenings                                                :

       (e) Cage and platform and fittings, guides, buffers,         :
            interior or the hoistway, or lift-way

       (f) Overrunning devices                                                 :

       (g) Suspension ropes or chain their attachments              :

       (h) Safety gear i.e. arrangements for preventing               :
            fall of platform or cage brakes.

       (i)  Brakes                                                                     :

       (j)  Worm or spur gearing                                              :

       (k) Other electrical equipment                                        :

       (l)  Other parts                                                              :

6.    What parts (if any) were inaccessible ?                           :

7.    Repairs, renewals of alterations (if any)                          :
       required and the period within which they
       should be executed

8.    Maximum safe working load subject to repairs               :
       renewals or alterations (if any) specified in item 7

9.    Other particulars                                                           :

         I/We certify that on (date) ……………………………… I/We have thoroughly examined this hoist or lift and the above is a correct report of the result.

                                                                                                Signature & name of the

                                                                             competent person

                                                                             Number & date of the

                                                                             competency certificate

Date :                                                                                      

                                                                             Issued by