Labour Commissioner 
(PRESCRIBED UNDER RULE 55)
PRESCRIBED FOR REPORT OF EXAMINATION OF HOIST OR LIFT/ OCCUPIER/ (OR OWNER) OF PREMISES
ADDRESS:
1. (a) Type of hoist or lift and Identification number or description.
(b) Date of construction or re-construction (if ascertainable).
2. Design and construction.
Are all parts of the hoist or life of good mechanical construction sound material and adequate strength (so as ascertainable).
3. Maintenance.
Are the following parts of the hoist 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 gate(s).
(c) Interlocks on the landing gates and cage gate(s).
(d) Other gates fastenings.
(e) Cage and platform and fittings guides, buffers, interior of the hoist way or lift way.
(f) Over-running devices.
(g) Suspension ropes or chain and their attachments.
(h) Safety gear, i.e. arrangements for preventing fall of platform or cage brakes.
(i) Brakes.
(j) Worm or super gearing.
(k) Other electrical equipment.
(l) Other parts.
4. What parts (if any were) inaccessible.
5. Repairs, renewals or alterations (if any) required and the period with which they should be executed.
6. Maximum safe working load subject to repairs, renewals or alterations (if any) specified in (5).
7. Others.
I/We verify that on .......................I/We thoroughly examined this hoist of life and that above is correct report of the result.
Signature............. Counter signature...........
If employed by a company or association give names and address.
Qualification ...........................................................
Address..................................................................
Date ................................
Note:- Details of any renewal or alterations required should be given in 5 above.