Form 13 (See Rule 72) REPORT OF EXAMINATION OF HOISTS AND LIFTS 1. Name of Occupier with Address 2. Name of Manager 3. (a)Type of hoist or lift identification number or description (b)Date of Construction or re- construction (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 hoists or lift properly maintained and in good working order ? If not, state what defects have been found. (a) Enclosure of hoist-way or lift-way (b) Landing gates and cage gates (c) Interlocks and the landing gates and cage gate(s) (d) Other gate fastenings (e) Cage and platform and fittings, guides, buffers, interior of the hoist way or life-way. (f) Overrunning devices (g) Suspension ropes or chain and their attachments (h) Safety gears i.e., arrangements for preventing fall of platform or cage breaks (i) Brakes (j) Worm or Spur gearing (k) Other electrical equipment (l) Other parts 4). What parts (if any) where inaccessible? 5). Repairs, renewals or alternation (if any) required and period within which they should be executed. 6). Maximum safe working load subject to repairs, renewals or alterations ( If any ) specified in item (5). 7). Other particulars I/we certify that on (date) ........... I/We thoroughly examined this hoist or lift and that the above is a correct report of result. Signature Qualification Address Date (If employed by a company or association, name and address of the company or association).
