Form 03

[See rule 4 (8)]

Certificate of competency issued to a person or an institution

I....................... in exercise the power conferred on me under section 2(1) of The

Occupational Safety, Health and Working Conditions Code 2020 and the rules made there

under, here by recognize Shri (if employed in Name of institution). .............to be competent

person for the purpose of preparation of plans, carrying tests, examinations, inspections and

certification for such buildings, dangerous machinery, lifts, tackles, pressure plants, confined

space, ventilation or plant and equipment as the case may be in an establishment located in

Union Territory of Lakshadweep under section [ ] of the Code and the rules made

there under.

This certificate is valid from..................to.......................

This certificate is issued subject to the following conditions as stipulated there under-

1. tests, examinations, inspections and shall be carried out in accordance with the

provisions of Code and the rules made there under.

2. tests, examinations, inspections and shall be carried out under the direct supervision of

competent person

3. the certificate of competency shall stand cancelled if the person declared competent

leaves the institution.

4. Competent person or institution shall submit reports as per provisions of the Code.

5. Any other condition Inspector-cum-Facilitator may think fit.

Place

Date official seal & signature

Chief Inspector-cum-Facilitator

Union Territory Administration of Lakshadweep