僱主或承建商姓名或名稱

表 格 三 [規例第 35(3)條]
Name or Title of Employer FORM 3 [reg. 35(3)]
or Contractor ...................
.............................................
建築地盤(安全)規例
............................................. 吊重機
每六個月一次的徹底檢驗結果報告
建築地盤地址 本表格乃由勞工處處長為施行建築地盤(安全)規例第 35(3)條而認可
Address of Site
.............................................
Construction Sites (Safety) Regulations
.............................................
HOISTS
REPORTS OF RESULTS OF SIX-MONTHLY THOROUGH EXAMINATIONS
Form approved by the Commissioner for Labour for the purposes of
regulation 35(3) of the Construction Sites (Safety) Regulations

徹底檢驗結果
吊重機的說明， 前次徹底檢驗日期 詳細註明所需進行的修理工作或毛病所在。 執行或負責 檢驗日期
例如：類別，識明標誌，容量 Date of last 如無不妥，則註明「處於安全操作狀況」 檢驗者簽署 Date of
Description of hoist previous thorough Result of thorough examination. Signature of examination
e.g. type, identification examination Enter details of repairs person making or
mark, capacity required or defects. responsible for
If none enter ‘In safe working examination
condition’.

(1) (2) (3) (4) (5)

任何合資格檢驗員或合資格的人，如向承建商交付他明知有任何要項屬虛假的證明書或報告，即屬犯罪；一經定罪，可處罰款二十萬元及監禁十二個月。
Any competent examiner or competent person who delivers to a contractor a certificate or makes a report which is to his knowledge false as to a material
particular shall be guilty of an offence and shall be liable on conviction to a fine of $200,000 and to imprisonment for 12 months.
CSSR-F3