Form XII

(See Rule-34)

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.

Name of the Where situated Registration no. of LIN No. of the

establishment, lifting lying/ used/ location the establishment establishment

appliance, lifting

device, transport

equipment, ladders

and staging

1 2 3 4

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 establishment 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 :

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.

Sir,

The contravention notified by you have been effectively attended to. The establishment, lifting

appliance, loose gears or similar gear, transport equipment, ladders and staging, scaffold shall be

ready for inspection on the date

Sir,

The contravention notified by you have been effectively attended to. The establishment, lifting

appliance, loose gears or similar gear, transport equipment, ladders and staging, scaffold shall be

ready for inspection on the date and place named below:

Date of Inspection Place

Dated at ____________ this day of ________ Employer, Occupier, Owner, Manager, Master,

20________ Officerin- charge or Agents, owner of machinery

and gear or the person, who by himself, his

agents or his employers, carried on the

establishment.

To

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

2020

PART - II

Improvement Notice

Inspector-cum-Facilitator's 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, Where Port of Registry Official no.(if any) of

lifting appliances, loose gear, situated/lying the ship

lifting device, transport, used/location

equipment, ladders and

stagings, scaffold;

An inspection of the above-named establishment, dock, 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 under the Occupational Safety, Health and

Working Conditions Code, 2020

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.

The requirements noted by you have been effectively fulfilled. The establishment, lifting

appliance, loose gear, lifting devices, transport equipment, ladders and staging, scaffold will be ready

for inspection on the date and place named below:

Date of Inspection Place

Dated at __________this day of Employer, occupier, Owner, Master, Manager, Officer-

________ in-charge or Agents, owner of machinery and gear or

20________ the person, who, by himself, his agents or his

employers, carried on the establishment.

To

The Inspector-cum-Facilitator under the Occupation Safety, Health and Working Conditions Code,

2020.