Govt. of India, Ministry of Labour & Employment

FORMS UNDER BOCW(RECS) ACT,1986

 

FORM-I

{See Rule 23(1)}

APPLICATION FOR REGISTRATION OF ESTABLISHMENT EMPLOYING BUILDING WORKERS.

  

1.  Name and location of the establishment                 :

where building or other construction work

is to be carried on. 

 

2.  Postal address of the establishment.                      :

 

3.  Full name and permanent address of the               :

establishment, if any.

 

4.  Full name and address of the manager or person :

responsible for the supervision and control

of the establishment.

 

5.  Nature of building or other construction work         :

to be carried on in the establishment

 

6.  Maximum number of building workers to be           :

employed on any day.

 

7.  Estimated date of commencement of building or   :

the other construction work.

 

8.  Estimated date of completion of the building or     :

other construction work

 

9.  Particulars of demand draft, enclosed (name of    :

the bank amount, demand draft No. and date).

 

 Declaration by the employer

 

(i)      I hereby declare that the particulars given above are true to the best of my knowledge and belief.

 

(ii)      I undertake to abide by the provisions of the Building and Other Construction Workers' (Regulation of Employment and Conditions of Service) Act, 1996 and the Rules made there under.

 

 

                             Principal Employer

                                           (Seal and Stamp)

 

 

Office of the Registering Officer appointed under the Building and Other Construction Workers' (Regulation of Employment and Conditions of Service) Act, 1996 and Central Rules made there under.

 

Date of Receipt of application :

                                                             

                                              

                                                        

 

                                 FORM-IV

                                      {(See Rule 26(3) and 239(1)}

                             Notice of commencement/completion of building or other construction work.

  

1  (i)

Name and address (permanent) of the establishment

 

   (ii)

Name of the employer and address

 

2.

Name and situation of place where the building and other construction is proposed to be carried on.

 

3.

No. and date of Certificate of registration.

 

4.

Name and address of the person in charge of construction work.

 

5.

Address to which the communications relating to building or other construction work may be sent.

 

6.

Nature of work involved and the facilities including plant or machinery provided.

 

7.

The arrangement for storage of explosive, if any, to be used in building or other construction work.

 

8.

In case the notice is for commencement of work, the approximate duration of work.

 

  

            I/We hereby intimate that the building or other construction work (Name or work) having registration No.  …………………………….. dated ………………….. is likely to commence/is likely to be completed with effect from ………………. (date)/on …………………..(date).

  

                                                                                    Signature of the Employer

 

To,

             The Inspector,

            ………………………..

            ……………………….

 

  

FORM V

(See rule 56 and 74(b), Schedule I)

 CERTIFICATE OF INITIAL AND PERIODICAL TEST AND EXAMINATION OF WINCHES, DERRICKS AND THEIR ACCESSORY GEAR

 

Test Certificate No………………

 

(a)       In case of construction site, name of the construction site where lifting appliances are fitted/installed/located :

 

Situation and description of lifting appliances and Gear with distinguishing number or marks (if any), which have been tested, thoroughly examined

Angle to the horizontal of derrick boom at which test load applied

Test  load applied

1

2

3

 

 

 

 

 

 

  

Safe working load at the angle shown in column

Name and address of public service, association, company, or firm or testing establishment making the test and examination

Name and position of the Competent Person of public service, association, company or firm or testing establishment.

4

5

6

 

 

 

 

 

 

 

 

  

      I certify that on the  ……………… day of ………………. the lifting appliance shown in column (I) together with its necessary gear was tested in the manner set forth overleaf in my presence; that a careful examination of the said lifting appliances after the test showed that it had withstood the test load without injury or permanent deformation; and that the safe working load of the said lifting appliance and necessary gear is as shown in column (4).

 

Signature of the Competent Person

 

Seal                                                                                                                      Date

 

 

Registration/Authority number of the Competent Person.

 

 

FORM VII

                                                                 {(See rule 70 and 74(b)}

CERTIFICATE OF INITIAL AND PERIODICAL TEST AND EXAMINATION OF LOOSE GEARS

  

Test Certificate No. …………………….

 

(a)       Name of the construction site where loose gears are fitted/installed/located.

 

 

Distinguishing Number or Mark

Description, dimension and material of gear/devise

Number rested

Date of test

Test load applied (tones)

1

2

3

4

5

 

 

 

 

 

 

 

 

 

 

 

 

 

Safe working load (SWL) (tones)

Name and address of manufacturer of suppliers

Initial test and examination certificate No. and date (only in case of periodical test and examination)

Name and address of public service association, company or firm or testing establishment making the test and examination

Name  and position of Competent Person in public service, association, company or firm or testing establishment

6

7

8

9

10

 

 

 

 

 

 

 

 

 

  

      I certify that on the  ……………… day of ………………. the above gear was tested and examined in the manner set  forth overleaf; that the examination showed the said gear/devise withstood the test load without injury or deformation; and that the safe working load of the said gear/device is as shown in Column 6.

 

 

Signature of the Competent Person  Seal                                                    Date

              

 Registration/Authority number of the Competent Person.

 

 

FORM VIII

                                                                {(See rule 62 and 74(b)}

 CERTIFICATE OF TEST AND EXAMINATION OF WIRE ROPE BEFORE BEING TAKEN INTO USE.

 

Test Certificate No. …………………….

 

1.

 

Name and address of maker or supplier

 

2.

(a)

Circumference/diameter of rope

 

 

(b)

Number of strand

 

 

(c)

Number of wires per strand

 

 

(d)

Lay

 

 

(e)

Core

 

3

 

Quality of wire 9e.g. Best Plough steel)

 

4

(a)

Date of test of sample of rope

 

 

(b)

Load at which sample broke (tones)

 

 

(c)

Safe working load or rope (tones)

 

 

(d)

Intended use

 

5

 

Name and address of public service, association, company or firm or testing establishment making the test and examination.

 

6.

 

Name and position of Competent Person in public service, association, company or firm or testing establishment making the test and examination.

 

  

            I certify that the above particulars are correct, and that the test and examination were carried out by me and no defects affecting its safe working load (SWL) were found.

 

 

Signature of the Competent Person                                Seal                                                    Date

                 

 Registration/Authority number of the Competent Person.

 

  

 

FORM  IX

                                                                    {(See rule 72 and 74(b)}

                                                                       CERTIFICATE OF ANNEALING OF LOOSE GEARS

 

Test Certificate No. …………………….

 

1.         Name of the construction site where loose gears are fitted/installed/located.

  

Distinguishing Number or Mark

Description, of gear

Number of the certificate of test and examination

Number annealed

Date of annealing

1

2

3

4

5

 

 

 

 

 

 

 

 

 

 

 

 

 

Defects found at careful inspection after annealing

Name and address of public service association, company or firm or testing establishment carrying out the annealing and inspection

Name  and position of Competent Person in public service, association, company or firm or testing establishment

6

7

8

 

 

 

 

 

 

 

  

      I certify that on the date shown in Column (5) the gear described in columns (1) to (4) was effectually annealed under my supervision that after being so annealed every article was carefully inspection; and that no defects affecting its safe working condition were found other that those indicated in column (6).

 

Signature of the Competent Person                                   Seal                                                    Date

                 

 

Registration/Authority number of the Competent Person.

 

 

  

FORM  XII

                                                                       {(See rule 223(d)}

                                                             HEALTH REGISTER

                 (In respect of persons employed in Building and other construction work involving hazardous processes)

 

Name of the Construction Medical Officer/Medical Inspector.

 (a)       Mr………………….From ……………………… to ……………………………

(b)       Mr………………….From ……………………… to ……………………………

(c)        Mr………………….From ……………………… to ……………………………

  

Sl.No.

Work No.

Name of building worker

Sex

Age (on last birthday)

Date of employment on present work.

Date of leaving or transfer to other work.

1

2

3

4

5

6

7

 

 

 

 

 

 

 

  

 

 

Reason for leaving transfer or discharge

Nature of job or occupation

Raw Material bye-product handled

Date of Medical examination by certifying Surgeon Medical Inspector/CMO

Results of medical examination

8

9

10

11

12

 

 

 

 

 

 

 

 

If suspended from work, state period of suspension with detailed reasons

Certified fit to resume duty on with signature of Medical Inspector/C.M.O.

If certificate of unfitness or suspension issued to worker.

13

14

15

 

 

 

 

 

 

 

 

            

                                                                                                    Signature with date of Medical Inspector/C.M.O.

 

Note –   (i)       Column (8) – Detailed summary of reason for transfer or discharge should be stated.

(ii)        column (12) should be pressed as fit/unfit/suspended.

 

 

FORM  XIII

                                                                        {(See rule 230(a)}

 

                                NOTICE OF POISONING OR OCCUPATIONAL NOTIFIABLE DISEASES.

 

1.

Name and address of the employer

 

 

 

 

2.

Name of the building worker and his work No., if any

 

 

 

 

3.

Address of the building worker

 

 

 

4.

Sex and Age

 

 

 

5.

Occupation

 

 

 

6.

State exactly what the patient was doing at the time of contracting the disease.

 

 

 

7.

Nature of poisoning or disease from which the building worker is suffering

 

 

 

Date                                                                                                                        Signature of the employer/ CMO

 

 

Note -       When a building worker contracts any disease specified in Schedule XII, a notice in this form shall be sent forthwith to the Director General.

 

FORM XIV

[See Rule 210(7)]

 

REPORT OF ACCIDENTS AND DANGEROUS OCCURRENCES

 

1.

 

Name of the project/work

 

2.

 

Location of project/work

 

3.

 

Stage of construction work

 

4.

 

Particulars of Employer

 

 

a.

Main contractor firm/Co.

 

 

 

Name

 

 

 

Address

 

 

 

Phone Nos.

 

 

 

Nature of business

 

 

b.

Sub-contractor’s particulars.

 

 

 

Name

 

 

 

Address

 

 

 

Phone Nos.

 

 

 

Nature of business

 

5.

 

Particulars of injured person

 

 

a.

Name

 

(First)                   (Middle)             (Surname)

 

b.

Home Address

 

 

c

Occupation

 

 

d.

Status of worker:

 

Casual

Permanent

 

e

Sex:

Male                                       Female

 

f

Age

 

 

g

Experience

 

 

h

Marital status :

               Married/un-married/divorced

 

6.

 

Particulars of accident

 

 

a

Exact place where accident occurred

 

 

b.

Date

 

 

c.

Time

 

 

d.

What the injured person was doing at the time of accident ?

 

 

e.

Weather condition

 

 

f.

How long employed by you for this particular job ?

 

 

g

Particulars of equipment/machine/ tool involved and condition of the same after the accident occurred.

 

 

h.

Brief description of the accident

 

7.

 

Nature of injuries.

 

 

a.

Fatal

 

 

b.,

Non-fatal

 

 

c.

If non-fatal, state precisely the nature of injuries(Describe in detail the nature of injury, for instance fracture of right arm, sprain etc.) 

 

 

d.

First Aid:

Given                                             Not given

 

e.

If not, give the reasons

 

 

f.

Name and designation of the person by whom first-aid was given

 

 

g.

If admitted to hospital name of the hospital

 

 

 

Address of the hospital

 

 

 

Name of the Doctor.

 

 

 

Phone No.

 

8.

 

Mode of transport used Ambulance/ Truck/ Tempo/ Taxi/ Private Car

 

9.

 

How much time was taken to shift the injured person

 

 

 

If very late, state the reasons

 

 

b.

How the reporting was made ?

Telephone/ Telegram/ Special messenger letter

 

 

c.

Who visited the accident site first and what action was proposed by him?

 

 

d.

What are the actions taken for the investigation of the accident by the employer ? (Describe about photographs/ Video film/ measurements taken, etc.)

 

10.

 

Particulars of persons given witness.

 

 

a.

Name        Address         Occupation

 

 

1.

 

 

 

2.

 

 

 

3.

 

 

 

4.

 

 

 

b.

Whether Temporary/ Permanent

 

11.

 

Particulars in case of fatal

 

 

 

Date/Time

 

 

 

Whether registered with Building and Construction Workers’ Welfare Board. If yes, give Reg. No.

 

12.

 

Dangerous Occurrences as covered under the Regulation No. (Give details)

 

 

a.

Collapse or failure of lifting appliances, hoist conveyors, etc.

 

 

b.

Collapse or subsidence of soil, any wall, floor, gallery etc.

 

 

c.

Collapse of transmission towers, pipeline, bridges, etc.

 

 

d.

Explosion of receiver, vessel, etc.

 

 

e

Fire and explosion

 

 

f

Spillage or leakage of hazardous substances

 

 

g

Collapse, capsizing, toppling or collision of transport equipment

 

 

h

Leakage or release of  harmful toxic gases at the construction site.

 

 

i.

Failure of lifting appliance, loose gear, hoist or building and other construction work machinery, transport equipment, etc.

 

13.

 

Certificate from the Employer or authorized signatory.

 

 

            I certify that to the best of my knowledge and belief, the above particulars are correct in every respect.

 

 

Place  :                                                                                                           Signature

Date    :                                                                                                           Designation

 

 

C.C.    -           Forwarded for information and follow-up action :

 

1.

2.

3.

 Note-    If more than one person is involved, then for each person, information is to be filled up in separate forms.

 

 

 

 FORM XV

[See Rule 240]

 Register of building workers employed by the  employer

 

Name and address of the establishment where building and other construction work is to be carried on : .........

Name and permanent address of establishment : ..............

 

 

 

 

 

 

 

Nature and location of work : ...........

 

 

 

 

Sl. No.

Name and surname of workmen

Age and Sex

Father's/
Husband's name

Nature of Employment/ Designation

Permanent home address of workmen (Village and Tehsil / Taluk and District)

1

2

3

4

5

6

 

 

 

 

 

 

 

 

 

 

 

  

Local address

Date of commencement of employment

Signature or thumb-impression of workmen

Date of termination of employment

Reasons for termination

7

8

9

10

11

 

 

 

 

 

 

 

  

If the building worker is/was beneficiary, the date of registration as a beneficiary, the registration No. and  the name of Welfare Board.

Remarks

12

13

 

 

 

 

 

 

  

 

 

FORM XVI

 [See Rule 241(1) (a)]

 Muster Roll

 

Name and permanent address of the establishment

 

 Name and address of establishment where building or other construction work is carried on/is to be carried on

 

 

 

 

 

 

Nature of building or other construction work

 

 

Name and address of  Employer

 

 

 

 

 

 

For the month of

 

 

       

 

Sl. No.

Name of building worker

Father's / Husband's name

Sex

Dates

Remarks

1

2

3

4

5

6

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

FORM XVII

[See Rule 241 (1) (a)]

Register of Wages

 

Name and address of the establishment where building or other construction work is carried on : .....

Name and permanent address of Establishment : ....

 

 

Nature of building or other construction work : ....

Name and address of the employer: ....

 

 

 

 

 

 

 

Wage period: Monthly

 

 

Sl. No.

Name of workman

Serial No. in the register of workman

Designation / nature of work done

No. of days worked

Units of works done

1

2

3

4

5

6

 

 

 

 

 

 

 

  

 

Amount of wages earned

Daily rate of wages/piece rate

Basic wages

Dearness Allowances

Overtime

Other cash payments (Nature of payment to be indicated)

Total

7

8

9

10

11

12

 

 

 

 

 

 

 

 

Deductions, if any, (indicate nature)

Net amount paid

Signature / Thumb impression of workman

Initial of employer or his representative

13

14

15

16

 

 

 

 

 

  

 

FORM XVIII

[See Rule 241 (1)(a)]

 Form of Register of Wages-cum-Muster Roll

 

Name and address of the establishment where building

 or other construction work is carried on/is to be carried on : ...

Name and permanent address of establishment: ...

 

 

 

 

 

 

 

 

Nature of building or other construction work: ...

 

   

 

Sl. No.

Sl. No. in Register of building workers

Name of employee

Designation/ nature of work

Daily attendance units worked

 

Total attendance / units of work done

1

2

3

4

5

6

 

 

 

 

 

 

 

  

 

Amount of wages earned

Daily-rate of wages/piece-rate

Basic Wages

Dearness allowance

Overtime

Other cash payment (nature of payments to be indicated)

Total

7

8

9

10

11

12

 

 

 

 

 

 

 

 

 

Deduction, if any, (indicate nature)

Net amount paid

Signature / Thumb impression of workman

Initials of employer or his representative

13

14

15

16

 

 

 

 

 

 

 

 

FORM XIX

[See Rule 241 (1) (b)]

Register of Deductions for Damage or Loss

 

Name and address of establishment where building or other construction work is carried on/is to be carried on : ...

Name and permanent address of building workers: ...

 

 

Name and permanent address of the employer: ...

 

 

Name of building or other construction work : ...

 

 

 

  

Sl. No.

Name of work

Father's / Husband's name

Designation/ Nature of Employment

Particulars of damage or loss

Date of damage or loss

Whether building worker showed cause against deduction

1

2

3

4

5

6

7

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

 

 

Date of recovery

Name of person in whose presence building worker’s explanation was heard

Amount of deduction imposed

No. of installments

 

 

First installment

Last installment

8

9

10

11

12

 

 

 

 

 

 

 

 

 

 

 

 

FORM XX

[See Rule 241(1) (b)]

Register of Fines

 

Name and address of establishment where building or other construction work is carried on/is to be carried on : ...

Name and permanent address of establishment : ...

   

 

 

Name of building or other construction work: ... 

Name and address of the Employer : ...

 

 

 

Sl.

No.

Name of the building worker

Father's/ Husband name

Designation / nature of employment

Act/ Omission for which fine imposed

Date of offence

1

2

3

4

5

6

 

 

 

 

 

 

 

 

 

Whether building worker showed cause against fine

Name of person in whose presence building worker’s explanation was heard

Wage periods and wages payable

Amount of fine imposed

Date on which fine realized

Remarks

7

8

9

10

11

12

 

 

 

 

 

 

 

 

 

 

FORM XXI

[See Rule 241(1) (b)]

Register of Advances

 

Name and address of establishment where building or other construction work is carried on/is to be carried on: ...

Name and permanent  address of Establishment : ...

 

 

Name and address of the Employer: ...

 

 

Nature of building or other construction work: ...

 

   

 

 

Sl.

No.

Name

Father's/ Husband name

Nature of employment Designation

Wage period and wages payable

Date & amount of advance given

1

2

3

4

5

6

 

 

 

 

 

 

 

 

 

 

 

 

  

Purpose(s) for which advance made

No. of installments by which advance to be repaid

Date & amount of each installment repaid

Date on which last installment was repaid

Remarks

7

8

9

10

11

 

 

 

 

 

 

 

 

 

 

 

 

  

 

FORM XXII

 [See Rule 241(I) (c)]

 Register of Overtime

 

Name and address of establishment where building or other construction work is carried on/is to be carried on : ...

Name and  permanent address of Establishment : ...

   
   

 

 

 

 

 

Sl. No.

Name of the building worker

Father's / Husband's name

Sex

Designation/ nature of employment

Date on which overtime worked

1

2

3

4

5

6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

Total overtime worked or production in case of piece work

Normal rates of wages

Overtime rate of wages

Overtime earnings

Date on which overtime wages paid

Remarks

7

8

9

10

11

12

 

 

 

 

 

 

 

 

 

 

  

 

 

FORM XXIII

[See Rule 241(2) (1)]

Wage Book

 

Name and address of employer: ...

Name and permanent address of establishment: ...

   

 

 

Nature  and address of the establishment where building or other construction work is carried on : ...

 

Nature of building or other construction work : ...

 For the Week/Fortnight/Month ending : ...

 

 

 

 

1.

No. of days worked

 

 

   

 2.

 No. of units worked in case of piece

 

 

rate workers       

 

 

 

 

 3.

 Rate of daily/monthly wages/piece-rate

 

 

 4.

 Amount of overtime wages

 

 

 

 5.

 Gross wages payable

 

 

 

 

 6.

 Deductions, if any on account of the following

 

 

 

 

 (a)

(b)

(c)

(d) 

(e)

 

(f)

 

 

 

7.

 Fines

Damage or loss

Loans and advances

Subscription towards provident fund

  Subscription towards         the Building Workers’ Welfare Fund

Any other deductions e.g. subscriptions to Co-operative Society or account of loans from Co-operative Society/ housing loan, or contribution to any relief fund as per provision of clause (p) of sub-section (2) of section 7 of the Payment of Wages Act or for payment of any premium of Life Insurance Corporation.

 Net amount of wages paid

 

 

 

 

 

 

 

 

 

 

 

Initials of the employer  or his
Representative

 

 

 

FORM XXIV

[See Rule 241(2)(b)}

Service Certificate

 

Name and permanent address of the establishment: ...

 

Name and address/location where the building or other construction work carried on/to be carried on : ...

 

 

 

 

 

 

 

 

 

 

 

Nature and location of work: ...

 

 

 

 

Name and address of the workman: ...

 

 

 

 

 

 

 

 

 

 

 

 

 

Age or Date of Birth : ...

 

 

 

 

Identification Marks: ...

 

 

 

 

Father's / Husband's name: ...

 

 

 

  

Sl.No.

Total period for which employed

Nature of work done

Rate of wages (with particulars of unit in case of piece work)

If the building worker was beneficiary his registration No., date and the name of the Board

From

To

1

2

3

4

5

6

 

 

 

 

 

 

 

 

 

                                                                               

Reasons/ground on which the employment terminated

                             Remarks

7

8

 

 

 

 

 

 

                                                                                                                           

                                                                                                                                                                                                                                Signature

 

 

 

FORM XXV

(See Rule 242)

ANNUAL RETURN OF EMPLOYER TO BE SENT TO THE  REGISTERING OFFICER

 

                        Year ending 31st December ……………

 

1.

 

Full name and full address of the establishment of the building and other construction work (Place, Post Office, District)

 

2.

 

Name and permanent address of the establishment

 

3.

 

Name and address of the employer

 

4.

 

Nature of building and other construction work carried on

 

5.

 

Full name of the Manager or person responsible for supervision and control of the establishment

 

6.

 

Number of building workers ordinarily employer

 

7.

 

Total number of days during the year on which building workers were employed.

 

8.

 

Total number of man-days worked by building workers during the year

 

9.

 

Maximum number of building workers employed on any day during the year

 

10.

 

The number of accidents that took place during the year as under -

 

 

a.

The total number of accidents.

 

 

b.

The number of accidents resulting in disablement of building workers for less than 48 hours, the number of building workers involved and the number of man-days lost.

 

 

c.

The no. of accidents resulting in disablement of building workers beyond 48 hours but not resulting in ay permanent partial or permanent total disablement, the number of building workers involved, and the number of man-days lost on account of such accidents.

 

 

d.

The number of accidents resulting in permanent partial or total disablement, the number of building workers involved and the number of man-days lost on account of such accidents,.

 

 

e.

The number of accidents resulting in death of building workers and the number of resultant deaths.

 

 

            The Chief Inspector or Inspectors appointed by a State Government under the Act shall direct the owners of establishments registered under this Act, to send the copies of Annual Returns submitted by the employer of registered establishments in respect of the concerned State Government or appropriate Government to the Director General of Inspections by virtue of provisions of section 60 of the Act.

             The Chief Inspector or Inspectors appointed under this Act by a State Government shall direct the owners of such establishments as are registered under this Act by registering officers appointed by the concerned State Government to send copies of the Annual Returns to the Director General by virtue of provisions of section 60 of the Act.

11.       Change, if any, in the management of the establishment, its location, or any other particulars furnished to the Registering Officer in the application for Registration indicating also the dates.

 

 

Place                                                                                                                                                              Employer

Date

 

 

FORM XXVI

{(See Rule 74(b)}

 REGISTER OF PERIODICAL TEST – EXAMINATION OF LIFTING APPLIANCE AND GEARS ETC.

 

                                                                                                            PART –I

Initial and periodical load test of lifting appliances and their annual thorough examination

 

“Thorough examination” means a visual examination, supplemented, if necessary, by other means such as a hammer test, carried out as carefully as the conditions permit, in order to arrive at a reliable conclusion as to the safety of the parts examined, and if necessary, for such examination parts of the lifting appliances and gear shall be dismantled.

 

                                                                                                               A

Initial and periodical load test of lifting appliance

 

Situation and description of lifting appliances tested with distinguishing number of marks, is any

No. of certificate of test and examination of competent person

I certify that on the date on which I have appended by signature the lifting appliance shown in column (I) was tested and no defects affecting its safe working condition were found other that those shown in column (5)

Remarks (to be signed and dated

Date and signature with seal

Date and signature with seal

1

2

3

4

5

           

 

                                                                              B

                                                     Annual thorough examination

 

I certify that on the date to which I have appended my signature, the lifting appliance shown in column (1) was thoroughly examined and no defects affecting its safe working conditions were found other than those shown in column (12)

        

Date & signature with seal

Date & signature with seal

Date & signature with seal

Date & signature with seal

Date & signature with seal

Date & signature with seal

Remarks (to be signed and dated)

6

7

8

9

10

11

12

 Note - If all the lifting appliances are thoroughly examined on the same date it will be sufficient to enter in column (1) “All lifting appliances”, if not, the parts which have been thoroughly examined on the dates must  be clearly indicated.

 

 

     PART-II

Initial and periodical load test of loose gears and annual thorough examination

 

 

List of loose gear

 The following classes of loose gears namely :

1.            Chains made of malleable cast iron.

2.            Plate link chains

3.            Chains, rings, hooks, shackles and swivels made of steel

4.            Pitched chains.

5.            Rings, hooks, shackles and swivels permanently attached to pitched chains, pulley blocks, container, spreaders, trays, slings, baskets, etc., and any other similar gear.

6.            Hooks and swivels having screw-threaded parts or ball bearings or other case-hardened parts and

7.            Bordeaux connection

 

Initial Test and periodical load test of loose gears

 

Distinguishing No. or marks.

Description of loose gear tested and examined

No. of certificates of test and examination of competent person

I certify that on the date on which I have appended by signature the lifting appliance shown in column (I) was tested and no defects affecting its safe working condition were found other that those shown in column (5)

Date and signature with seal

Date and signature with seal

1

2

3

4

5

 

Annual thorough examination of loose gears

  

Remarks (to be signed and dated)

I certify that on the date to which I have appended my signature, the loose gears shown in columns (1) and (2)  were thoroughly examined and no defects affecting their safe working conditions were found other than those shown in column (10)       

 

 

Date and signature with seal

Date and signature with seal

Date and signature with seal

Remarks (to be signed and dated)

6

7

8

9

10

 

PART- III

 Annealing of Chain, Rings, Hooks, Shackles and Swivels (other than those exempted)

  (See PART II)

 

12.5 mm and smaller chains, rings, hooks, shackles and swivels in general use.

If used with lifting appliance driven by power, must be annealed once at least in every six months.

If used solely with lifting appliance worked by hand, must be annealed once at least in every twelve months.

 

Other chains, rings, hooks, shackles and swivels in general use.

If used with lifting appliance driven by power, must be annealed once at least in twelve months.

If used solely with lifting appliance worked by hand, must be annealed once at least in every two year

  

Note.   It is recommended though not required by rules that annealing should be carried out in a suitably constructed furnace heated to temperature between 1100 degree and 1300 degree Fahrenheit or 600 degree centigrade, for a period between 30 and 60 minutes.

 

Distinguishing No. or marks.

Description of  gear annealed

No. of certificates of test and examination.

I certify that on the date on which I have appended by signature, the gear described in Col. 1 and 2 was effectually annealed under my supervisions; that after being so annealed every article was carefully inspected and that no defects affecting its safe working condition were found other than those shown in Col. 7

Remarks (to be signed and dated)

Date and signature with seal

Date and signature with seal

Date and signature with seal

1

2

3

4

5

6

        7.