Form 11

(See Rule 62 & 64)

Report of Examination of hoist, lift, Lifting Machine, chains, Ropes & Lifting Tackles
1. Name of the Occupier :

2. Name & address of the factory :

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

Lifting Machine, chains, Ropes & Lifting Tackles Size: 8100 x 1300 x1000.
2

Date of Construction or Reconstruction & the date when : 2011.

The hoist, lift, Lifting Machine, chains, Ropes & Lifting
Tackles were first taken into use in the factory

4. Date of last examination made under section 28 (1) : First time tested by us on 10-06-2011
(a) (ii) & 29 (1) (a) (iii) & by whom it was carried out
5. (A) Maintenance: (List of parts, if any, which were inaccessible)
Are the following parts of the hoist or lift properly
maintained and are in good working order?
If not state what defects have been found:(a) Enclosure of hoistway or liftway : Not Applicable
(b) Landing gates and cage gate(s) : Not Applicable
(c) Interlocks on the landing gates and cage gate(s) : NIL
(d) Other gates fastening : NIL
(e) Cage and Platform and fittings, cage guids, : NIL
Buffers, Interior of the hoistway or liftway
(f) Overrunning Device : DFT Basket

(g) Suspension ropes or chains and Their attachments : Good

(h) Safety gear, i.e., arrangements for preventing fall : NIL
Of Platform or Cage brakes
(i) Brakes : Not Applicable
(j) Worm of spur Gearing : Not Applicable
(k) Other electrical equipment : Not Applicable.
(l) Other Parts : Good

(B). Date and number of the certificate relating to : Tested by us on 10-06-2011

any test and examination made under sub-rule
(1) of Rule 64 together with name of the
person who issued the certificate

(C) (i) Date of annealing or ther heat treatment of the : Not Applicable
Chain & lifting tackle carried out under sub-rule
(5) of rule 64 and whom it was carried out.
(ii) Particulars of any defect found at any such : Tested at 25 Ton & Found O.K.
examination or after annealing and affecting
the safe working load and of the steps taken to
remedy such defect.

6. Repairs, Renewals or alteration (if any) required & the : Not Applicable
period within within which they should be executed
maximum safe working load subject to repairs, renewals
or alterations (if any)

I/We certify that on 10-06-2011, I/We thoroughly examined the hoist, lift, Lifting Machine,

chains, Ropes & Lifting Tackles and details of examinations/test carried out is enclosed herewith hat
the above is a correct report or the result.

Countersignature
...
if employed by a company or Association
Give name and address

SATYAM Engineers & Associates

Signature : S.K. SARKAR
Qualification : C.P.C. No. S-43/2011

A/6, Vandana CHS., Nilemore, Nallsopara (w),

Thane, Maharashtra 401 203.

Address : (UNDER FACTORY ACT)

Date : COMPETENT PERSON

Tel Fax: 0250 2413027

E-mail:- satyamengineers@gmail.com

R
ef.No.42
6/11

Form 11
(See Rule 62 & 64)
Report of Examination of hoist, lift, Lifting Machine, chains, Ropes & Lifting Tackles
1. Name of the Occupier : M/s. Parveen Industries Pvt. Ltd.

2. Name & address of the factory : M/s. Parveen Industries Pvt. Ltd..
Plot No. R-55, T.T.C. Industrial Area,
MIDC,,
Rabale, Navi Mumbai

3. (a) Type identification number or description of hoist, lift, : DFT Basket, Cap.: 10 Ton, Sr. No.: TYPE-1-04,
Lifting Machine, chains, Ropes & Lifting Tackles Size: 8100 x 1300 x1000.
2.

Date of Construction or Reconstruction & the date when : 2011.

The hoist, lift, Lifting Machine, chains, Ropes & Lifting
Tackles were first taken into use in the factory

4. Date of last examination made under section 28 (1) : First time tested by us on 10-06-2011
(a) (ii) & 29 (1) (a) (iii) & by whom it was carried out
5. (A) Maintenance: (List of parts, if any, which were inaccessible)
Are the following parts of the hoist or lift properly
maintained and are in good working order?
If not state what defects have been found:(a) Enclosure of hoistway or liftway : Not Applicable
(b) Landing gates and cage gate(s) : Not Applicable
(c) Interlocks on the landing gates and cage gate(s) : NIL
(d) Other gates fastening : NIL
(e) Cage and Platform and fittings, cage guids, : NIL
Buffers, Interior of the hoistway or liftway
(f) Overrunning Device : DFT Basket
(g) Suspension ropes or chains and Their attachments : Good
(h) Safety gear, i.e., arrangements for preventing fall : NIL

Of Platform or Cage brakes

(i) Brakes : Not Applicable
(j) Worm of spur Gearing : Not Applicable
(k) Other electrical equipment : Not Applicable.
(l) Other Parts : Good

(B). Date and number of the certificate relating to : Tested by us on 10-06-2011

any test and examination made under sub-rule
(1) of Rule 64 together with name of the
person who issued the certificate

(C) (i) Date of annealing or ther heat treatment of the : Not Applicable
Chain & lifting tackle carried out under sub-rule
(5) of rule 64 and whom it was carried out.
(ii) Particulars of any defect found at any such : Tested at 25 Ton & Found O.K.
examination or after annealing and affecting
the safe working load and of the steps taken to
remedy such defect.

6. Repairs, Renewals or alteration (if any) required & the : Not Applicable
period within within which they should be executed
maximum safe working load subject to repairs, renewals
or alterations (if any)

I/We certify that on 10-06-2011, I/We thoroughly examined the hoist, lift, Lifting Machine,

chains, Ropes & Lifting Tackles and details of examinations/test carried out is enclosed herewith hat

the above is a correct report or the result.

Countersignature
...
if employed by a company or Association
Give name and address

SATYAM Engineers & Associates

Signature : S.K. SARKAR
Qualification : C.P.C. No. S-43/2011

A/6, Vandana CHS., Nilemore, Nallsopara (w),

Thane, Maharashtra 401 203.

Address : (UNDER FACTORY ACT)

Date : COMPETENT PERSON

Tel Fax: 0250 2413027

E-mail:- satyamengineers@gmail.com