[See Rule 56]


1. Name of Occupier (or factory)

2. Situation and address of factory 

3. Name, description and distinctive number of pressure vessel or plant.

4. Name and address of manufacturer and reference to their test certificate or certificate of competent person 

5. Nature of process in which it is used. 

6. Particulars of pressure vessel or Plant. 

(a) Date of construction
(b) Thickness of wall
(c) Date on which the pressure vessel or plant was first taken into use 
(d) Maximum permissible working pressure recommended by the manufacturer
(c) Design pressure, if known
(The history should be briefly given and the examiner should state whether he has seen the last previous report)

7. Date of last hydrostatic test (if any) and pressure applied 

8. Is the pressure vessel or plant in open or otherwise exposed to weather or to damp ?

9. What parts (if any) were inaccessible ?

10. What examination and tests were made (Specify pressure if hydrostatic test was carried out)

11. Condition of pressure vessel or plant (State any defects materially affecting the maximum permissible working pressure or the safe working of the pressure vessel or plant) 



12. Are the required fittings and appliances provided in accordance with the Rules ? 

13. Are all fittings and appliances properly maintained and in good condition? Have the pressure settings been checked and corrected ? 

14. Repairs, if any, required, and period within they should be executed and any other condition which the person making the examination thinks if necessary to specify for securing safe working 

15. Maximum permissible working pressure, calculated from dimensions and from the thickness and other data ascertained by the present examination, due allowance being made for conditions of working if unusual or exceptionally severe (State minimum thickness of walls measured during the examination) 

16. Where repairs affecting the maximum working pressure are required, state the working pressure .

(a) Before the expiration of the period specified in (14) 
(b) After the expiration of such period if the required repairs have not been
(c) After the completion of the required repairs 

17. Other observations 


I certify that on ..................... . the pressure vessel or plant described above was thoroughly cleaned and (so far as its construction permits) made accessible for thorough examination and for such tests as were necessary for thorough examination and that on the said date, I thoroughly examined this pressure vessel or plant, including its fittings and that the above is a true report of my examination.

If employed by a company or   Association, give name and address Signature

Qualification ..................