Form No. 37

Name of the occupier of the factory:

Address of the factory:


Distinguishing number or mark, if any and description sufficient to identify the lifting machine, chain, ropes or  the lifting tackle

Date on which the lifting machine, chain, rope or lifting tackle was first taken use in the factory

Date and number of the certificate relating to any test and examination made under Rules(1) and (7) together with name and address of the person who issued the certificate

Date of each periodical thorough examination made under clause(v)(iii) of subsection (I) of Sec 29 of the Act and Rule 53(3)(vi) and by whom  it was carried out

Date of annealing or other heat treatment of the chain and the other lifting tackle made under Rule 55(3)(v) and by whom it was carried out

Particulars of any defect affecting the safe working load found at any such thorough examination or after annealing and of the steps taken to remedy such defects