Form XII

[Rule-24(1)]

IMPROVEMENT NOTICE AND PROHIBITION ORDER PART I

PROHIBITION ORDER

Inspector-cum-Facilitators Notice on Inspection of Establishment, Lifting Appliance, Loose

Gears and other such gears, Equipment, Ladders and Staging. Inspector-cum-Facilitator's notice to

the occupier, employer, owner, master, Officer-in-charge, Owner of lifting appliances, loose gears and

lifting devices or the person, scaffold who, by himself, his agents, or his employers as the case may

be.

An inspection of the above named establishment, lifting appliances, loose gears, lifting devices,

transport equipment, ladders and staging was made on .

The activities connected with establishments which are being carried on by you/about to be

carried on by you/under your control involve a risk or danger to the life. Safety and health of

employee and involve the following contraventions:

Name of the establishment,

lifting appliance, lifting device, Where situated Registration no. of LIN No. Of the

transport equipment, ladders lying/used/location the establishment establishment

and staging

1 2 3 4

CONTRAVENTIONS

Therefore, I hereby direct that the said activities shall not be carried on by you or under your

control unless the said contraventions and matters mentioned have been remedied to the satisfaction

of the Inspector-cum-Facilitator. This order is being issued without prejudice or any legal action which

may be taken for these contraventions.

On hearing from you that the requirements have been complied with the establishment, lifting

appliance, loose gear or similar gear/transport equipment/ladders/ staging, scaffold shall again be

visited with a view to the inspection being completed.

No.

Dated at this day of 20

Inspector-cum-Facilitator under the Occupational Safety, Health and Working Conditions Code, 2020

Requirements

On compliance with all or any of the above contraventions, the Inspector-cum-Facilitator shall be

informed in the manner prescribed overleaf, of the date and place at which the establishment, lifting

appliance, loose gears or similar gear transport equipment, ladders and staging, scaffold can be re-

inspected.

PART - II

IMPROVEMENT NOTICE

Inspector-cum-Facilitators notice to the employer, Owner, Master, Manager, Officer-in-Charge

or Agents, Owner of lifting appliances, loose gears lifting devices, scaffold or the person, who, by

himself, his agents or his employers, carries on the establishment, as the case may be.................

Name of the establishment, lifting

Where

appliances, loose gear, lifting device, Port of Official no.(if any) of

situated/lying

transport, equipment, ladders and Registry the ship

used/location

stagings, scaffold;

An inspection of the above-named establishment, ship, lifting appliances, loose gears, lifting

devices, transport equipment, ladders and stagings, scaffold was made on .............

The following contraventions were observed. You are required to remedy the said

contraventions and send the compliance report in writing within…………… days.

This notice is being issued without prejudice to any legal action which may be taken for these

contraventions on hearing from you that the requirements have been complied with the

establishment, lifting appliance/loose gear or similar other gear/transport equipment/ladders/ staging,

scaffold will again be visited with a view to the inspection being completed.

Contraventions No...................Dated...............this...............day of ..............20.....................

Inspector-cum-Facilitator

Requirements : On compliance with all or any of the requirements, the Inspector-cum-Facilitator

should be informed in the manner prescribed overleaf of the date and place at which the

establishment, lifting appliance, loose gear, transport equipment, ladders and staging, scaffold can be

re-inspected.