Acil Mmrda BL5463 06.10.2023 369

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JE/MMRDA/22-23/369

FORM 11
(SEE Rule 62 & 64)
(Report of Examination of Hoist or Lift, Machine, Chains, Ropes and Lifting Tackles.)

1 Name of the Occupier : M/S. AHLIUWALIA CONSTRUCT INDIA LTD.

2 Name and Address of the Factory : MMRDA MUMBAI METRO CARSHED,LINE 2B


MAHARASHTRA NAGAR MANKHURD (West) MUMBAI- 88
3(a) Type Identification number and description of hoist, : “MOBILE BOOM LIFT ”
lift, lifting machine, chains, ropes and lifting tackles. Make-JLG,Model-460ST,Sr.No.0300115463,
Boom Length-13mtr,Engine Make-DEUTZ-D2011-
L03,Cap- 500kg,SWL-160Kg, Working Height-48ft,
Location- MMRDA Mandale Depot Project
Work
(b) Date of construction or reconstruction and the date when
the hoist, lift, lifting machine, chains, ropes and lifting : 2017
tackles were first taken into use in the factory.
4 Date of last examination made under section 28 (1) (a) (ii) : 17.03.2023 BY US.
and 29 (1) (a) (iii) and by whom it was carried out.
5(A) Maintenance : List of parts, if any, which were
inaccessible) Are the following parts of the hoist of lift
properly maintained and in good working order? If not,
state what defects have been found -
(a) Enclosure of hoistway or liftway : Not Applicable.
(b) Landing gates and cage gate (s) : Not Applicable.
(c) Interlocks on the landing gates and cage gate (s) : Not Applicable.
(d) Other gates fastenings : Not Applicable.
(e) Cage and platform and fittings, cage guides, buffers, : Not Applicable.
interior of the hoistway or liftway
(f) Overrunning devices : Not Applicable.
(g) Suspension ropes or chains and their attachments : Not Applicable.
(h) Safety gear, i.e. arrangements for preventing fall of : Not Applicable.
platform or cage brakes
(i) Brakes : Okay.
(j) Work of spur gearing : Not Applicable.
(k) Other electrical equipment : Ok
(l) Other parts : Okay.
(B) Date and number of the certificates relating to any test : Thoroughly Examined Load test carried on 06.10.2023
and examination made under sub-rule (1) of rule 64 Along with Engineer of Occupier & found ok.
together with the name of the person who issued the
certificate
(C) (i) Date of annealing or the heat treatment of the chain : Not Applicable.
and lifting tackle carried out under sub-rule (5) of rule 64
and by whom it was carried out.
(ii) Particulars of any defect found at any such examination : Nil.
or after annealing and affecting the safe working load and
of the steps taken to remedy such defect.
6 Repairs, renewals or alterations (if any) required and the : Nil, Load Test @ 200kg, SWL-160kg (2 Person Only)
period with which they should be executed and maximum . Never Overload & Bypass Safety Systems Shall be
safe working load subject to repairs renewals or alterations properly maintained in safe working condition.
if any)
I/ WE CERTIFY THAT ON 06.10.2023 I / WE THOROUGHLY EXAMINED THE HOIST, LIFT, LIFTING MACHINE, ROPES AND LIFTING
TACKLES AND DETAILS OF EXAMINATIONS / TEST CARRIED OUT IS ENCLOSED HEREWITH THAT THE ABOVE IS A CORRECT
REPORT OF THE RESULT.NEXT DUE ON 05.04.2024 OR CHANGE IN LOCATION/ HEIGHT/EQUIPMENT STRUCTURE WHICHEVER
OCCURS FIRST.

Digitally signed by Preetam


Preetam Dattatray Dattatray Deshpande
Deshpande Date: 2023.10.22 13:19:43
+05'30'
Samarth Safety Services Preetam D. Deshpande
Januttam Engineers D.M.E., A.D.IS., Competent Person
Neel-Padma (A/5), Flat No.9, Savarkar Nagar, Approved by DISH, Govt. of Maharashtra
Manikbag, Sinhgad Road, Pune-411051. CPC No.MS/DISH/CPC/D-065
Mob. No. 8928858482/9834695558 [email protected]

Daily check the above equipment and all its safety devices for its proper Functioning and safe operation & favourable weather condition before using. Operation,
maintenance & safety of above equipment are in Occupier’s scope. Follow manufacturer’s instructions for safe operation & maintenance.
Mumbai Branch -Januttam Engineers, 603 L4, Swastik Sankul, Cluster 4, Near Shanti Garden Mira Road East Thane-401107 Phone-
8928858482

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