FORM NO.

10 (Prescribed under Rule 60) Prescribed for report of Examination of the lifting machines, ropes and lifting tackles PARTICULARS 1. 2. 3. 4. 5. 6. Name of occupier of factory Address of factory Distinguishing number or mark (if any) and description sufficient to identify the lifting machine, chain, rope or the lifting tackle. Date when the lifting machine, chain, rope or lifting tackle was first used in the factory. Date of each examination made under section 29(1) (a) (iii) and by whom it was carried out. Date and number of the certificate relating to any test and examination made under sub-rule (1) or rule60 together with the name of the person who issued the certificate. 7. 8. Date of annealing or other heat treatment if the chain and lifting tackle carried out under sub-rule (5) of rule 60 and by whom it was carried out. Particulars of any defect found at any such examination or after annealing and affecting the safe working load and the steps taken to remedy such defect. I/We certify that on I/We thoroughly examined the above mentioned lifting machine/chain/rope/lifting tackle and that the above is a correct report of the result. Signature .. Qualification .. Countersignature If employed by Company or Association give name and Address. Address . Date Date