Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

Regional Office No. XII, Koronadal City

APPLICATION FOR OVERHEAD/HOIST CRANE INSTALLATION

1. Name of Establishment: ___________________________________________________________________________

2. Address: _______________________________________________________________________________________
3. Owner/Manager/Address: _________________________________________________________________________
4. Where Crane is to be installed: ______________________________________________________________
______________________________________________________________________________________________
5. Plans to be submitted: Submit (in quadruplicate) the installation and location plans of the crane. The plans shall be
prepared, signed and sealed by a Professional Mechanical Engineer. Plans shall also bear the name and signature of
owner or manager of the establishment. The working drawing of the crane shall be submitted together with the First
Inspection Report.
6. Crane Data:

a. Manufacturer: ______________________________________________________________________________

b. Type: ______________________________________ c. Model System: ______________________________

d. Power System: ______________________________ e. Date of Make: _______________________________

f. Safety Working Load: __________________________________________________________________________

h. Max. Allow. WL: ____________________________ i. Capacity: ___________________________________

j. Standard Lift: _______________________________ k. Standard Hoist Speed: ________________________

7. Name and signature of person to supervise the installation: _______________________________________________

PRC License No.: _____________________________________________
Board of Mechanical Engineering License: _________________________
8. Other accessories or equipment: ____________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________

_________________________________
Name and signature of Owner/Manager
TIN: ___________________________

Application No.: _______________________

Plan Fee: ____________________________
O.R. No. : ____________________________
Date Received : _______________________
Received by: _________________________