TATA STEEL LIMITED

AERIAL LIFT PRE-USE INSPECTION

Vehicle Type:- HAULoTe CHECKLIST
HAvehicle Regn. No: ADI27242 DateInspection:03.07:2
Oepartmene.K MEC ARTICU LATED Contractor Name:
801 RT|260 Px} YoM-20s INV-20 1 aiuANDERS ARBUTHNOT
st. ( a A L MICeo.
No. ITEM TO BE INSPECTED OK REMARKS Action
NOT OK Recommended

Operating and emergency controls are in proper working condition, EMO button or
Emergency Stop Device
Vald wee
mankls |ll .
Functional
controls)
upper drive control interlock (l.e. foot

Emergency Lowering function operates properly

pedal, spring lock, or two hand
mehanfd15TEES
02 O¢T: 202

4
Lower operating controls successfully over ride the upper controls B Sign.
5 teats.
Both upper and lower controls are adequately protected from inadvertent 0712
operation. PMEN
6
Control panel is clean & all buttons/switches are clearly visible (no paint
etc. over spray%

All switch & mechanical guards are in good condition and properly installed
Lpal 82
AN-JDT-2. o8 2019
8AllSafety Indicator lights work
9
INY No-/026i 1-2
Drive controls function properly & accurately labeled (up, down, right, left, forward,
back) SHA SHAK UOUTAM
10 Motion alarms are functional
TTRANS
TSK PROJECT

11
Safety decals are in place and readable 38 SDEE:2
12 All guard rails are sound and in place, including basket chains
mmoHAN RAo)
13
Work platform & extension slides are clean, dry, & clear of debris rRSTO
14
a 7ose 363
Work platform extension slides in and out freely with safety locking pins in place to
lock setting on models with extension platforms.

inspect for defects such as cracked welds, fuel leaks,

T&L
hydraulic leaks, damaged
control cables or wire harness, etc.
K P:No!-I615I.
16
Tires and wheels are in good condition, with adequate air pressure if pneumatic

17
Braking devices are operating properly
18
The manufacturer's operations manual is stored on MEWP (in
P. yDAY
operators)
all languages of the Paeh ¢h palo
19
30 |9037S3
1Oil level, Hydraulic Oil Level, Fuel Level, Coolant Level
w

20 Battery Charge

21
Outriggers in place or fuictioning, Associatedalarms Morkig KLPR
N

S i g n .

1P
h

AFET
 PLOT NO: 1205/A, NAYAPALL,

tarlhasaulhi Lalai, s. Tech (Hons)

BHUBANESWAR-751012

TEL: 0674 2560284, CELL:

94371 32223

WAETAN" ENN UN SScton2(ca ne Factones Ac: 1948RECOGNITION NO: CP(0) NO S5(G) 3-Jul-2021|
1 Y1H1
ND 202/AIEWP/TSL-MICCO/HAULOTTE -HASO-7242/TC
TSL ID:TSK/PRO: 98

FORM 7-A
chains, ropes and liftingtackles
Keport of examination oflifting machines,
(2) of Section 29, Factory Rules, 1950J
Prsrikni under Rtule55-C, Sub-section TATA STEEL LTD
ame ot Orupier or Factory
Tata Steel Ltd.,
Addrs of the Factor
Kalinga Nagar Orissa Project,
Dubri, Odisha.
Equipment: ARTICULATED
Distinguishing number or mark if any, and description
Make: HAULOTTE GROUP
suticient to identity the litting machine, chain, rope or the
iting taukle: Model: HAS0 JRT
Sr. No: AD127242

Model Year: 2015

Unrestricted Capacity: 230kg
Reg. Ownwer: SHAKTI

EQUIPMENTS

Haulete Present Configuration of Man Liftat Site:

boom on hinges
Type: Tubeless Tyre Mounted, sliding
Max Platform height: 77feet
53 feet
Max horizontal reach of Platform:
Platform size: 36"x96"
Platform Lifting booms and Box booms and Hydraulic jacks
:2 points -Onewhile the operators stand
Operation on the ground and other is at the
Platform.
TSL, KPO
Location:
all the parts of hoist or lift of good Yes
Design and construction:Are
mechanical construction, sound' material
and adequate strength

so far as ascertainable)?
tackle was 03-07-2021
Date when the lifting machine, chain, rope or lifting
first taken into use in the factory.
2015
Date of construction (if ascertained)
or reconstruction
to test and
This is first examination Complying
Date and number of Certificates relating any
and 55-G together with the to Rule 55-A
examination made under rules 55-A
issued the certificate.
name and address of the person who Last examination done on -01-10-2019 by4
made under
Date of each periodical thorough examination Y. K. UPADHYAY at Maharastra
Rule 55-Fand the name of examiner:
Nil at the time of examination.
treatment of chain and other
Date of annealing or other heat
Rule 55-E and by whom it was
lifting tackle made under
10 Visual Inspection (for Maintenance)
order? If not state
Are the following parts of the hoists
or lift properly maintained and in good working
what defects have been found.
Good condition
a) Tyres Good condition
(b) Steering Good condition
(c) Limit switches & Siren Good condition
Over Load limit Switch

EXCEL FILESiSTD MANLIFTISTD MANLIFTS

-

MWEP
D:1Comp Person Workl5. STD REPORT page of 2
HAULOTTE - HA80 227242- TATA SHAKTIxlsx
 C o d andituor
ver Peach Lirmit zwitnh
Worirg
iren actiivatir tadre activatn th Linit zniv
Working
r e kad Indikatrs
(d afe Lad u d condition

ey perating Parel
at gourd Good condtuon

( operatir, Parel at Platfusn God conditio

for prevertirg fall «6 Mar
(g) safety Kat, ik, arranenert Good condition
(h) saks Good cordiion

(i Hydrauli h a n jaks God condiuon

B a n zeneral csnditim Good condiion
Platforn yereral cndition
k Good condiion
Prine nerver Ineermals of Engine and H:áev
What parts (if any) vWge inzccAiDk
11 Mechanis
Ni at the time of examinaion
Repairs, rerwal altration (if ary, reauired end tre
r perid
12
within which they shruld be eneued.

13 Load Testing Platfornwas kaded wih

54 The deflected
kg boom
a Static Tets At Ground lerel the cut of at 25kg
returned back to origiral position
after urioading The ing
smootn
b) Dynarnic Tests Al movements were tried witn25kg Motions were
while performing al operaions,
h e r e was no sin
ot
a
With the abre load and
(StabilityTests instabilit.
Nl at the time of amination.
of
Particulars any defects affecting the safe orking load found
eamination or after arnealirg and of
the
at any such thorough

stepstakern to rernedy such defects:

of 180kg.
operator/few materials subject
max
of Persons +
2
15 Maximum Safe nos

Working Capacity
Others

i t 23 ez r a i r

I certify that on -Jul-21 s2 z inaltin o

rEzssary
ari for sucn tasts s
zere
eranination
possible and made accesible for thorough ezzmineá tiis MAVIFT 2d iai tiz 2 r e is 2 o r e i r e n
the above MAN LIFT. I have thoroughly

30-Dac-21
Next due datefor examination
to be conducted by Competent Person sbject
to SOP&SMP

Tanaaaali A l a
Signature
Qualification: B.Tech (Hons).Competant
Person Recgn. No: CP(O)NO 55(G) Parhasarathn Dalal,8.Tech
Competani Person
Addres:PlotNo:1205/A.P.O Nayapalli.
Bhubaneswar 751012. Regi Na-0P(0) No-55/6)
Date 3-Jul-21
PSD/2021/MEWP/TSL-MICCO/HAULOTTE - HASO-7242/TC 1 Y1H1 Jul-021

MEP-
STD REPORT EXCEL FILES STD MANLIFTSTD MANLIFTS
-

DAComp Person Work5. page of 2

HAULOTTE - HA80-227242- TATA SHAKTIdsx-
 COMMERCIAL INVOICE

YRNE
EQUIPMENT SALES
DAIE

6/2/2019
INVOCE

109019

2001 E Hwy 40
Craig CO 81625
OS/16/2019
P AD

(970)826-0051
www.BymeEquipmentSales corg*
Sil
Pvt Ltd
Ltd Shakti Equipments 73a,76,76/1,77&78
Shakt1 Equipments Pvt 73a,76,76/1,77&78 Block No. 140
House No
VitawaOctroi
Block No. 140 House No VitawaCOctroi Opp Hotel Shri
Krishna, Near
Opp Hotel Shri Krishna, Near ThaneWest Naka, Thane Rd, Vitawa
Belapur
Vitawa,
Naka, Thane Belapur Rd, ThaneWest
400 605 Maharashtra, India 400 605 Maharashtra. India via Houston Pt

RCEACH AMUNT

22,500.00 22,500.00T
AH Terain Manlift/Boomlift. Deutz
wwww

Used 2015 Haulotte HAB0 JRT

Diesel engine s.n AD127242
3,000.00 3,000.00
Transport and delvery of unit via first avatable truck on space
will
available basis to the Port of Houstorn, TX unly Delivery date
be Monday Fnday, approximately 1-2 business days after pick-up
Selar
in Craig. CO Exact address to be provided by Buyer priorto
available or other
booking a truck. Buyer will have a loading dock will transfer to
means to unload if traiier type warrants. Ownesship
risk of loss arnd insurable
| Buyer upon receipt of payment andSetlers
interest will transfer to Buyer upon delivery of equipment to
registered cormman carrier

merchandise +
Payment Terms 100% of net purchase price
shipment
0.00% 0.00

in i ,

Total $25,500.00

All sales are as is where is. No warranties expressed or

implied unless staled in writing & signed. Balance Due $0.00
THE NEW INDIA ASSURANCE CO. LTD.
Govemmet of India Undertaking)

CONTRACTOR'S PLANT AND MACHINERY INSURANCE POLICY

Insured's Name l:SHAKTI EQUIPMENTS PRIVATE LIMITED

Insured's Detais Issuing Office Details
CustomerD :PO59829261 Office Code : COMMERCE CENTRE(131400)
:COMMERCE CENTRE,1ST FLOOR
Address BLOCK NO. 140, H.NO. Address TARDEO ROAD,400034
73A 76.76/1.77 &78.0PP. HOTEL SRI|
KRISHNA PARADISE. NEAR VITAWA
OCTROI NAKA,. 400034
THANE SELAPUR ROAD, VITAWA.
KALWA
KALWA MAHARASHTRA, 400605
Phone No Phone No :23513550
nia.131400@newindia.co.in/
EmailFex purchasse@shaktequipments.com, /E-mailUFax
S.Tax Regn. No_ :AAACN4165CST178
PAN No :AAJCS6S7H_
GSTIN :27AAACN4165C3ZP
GSTINUIN 27AAJCSSES7H1ZK/ NA
SAC :997137 (Other property insurance
services

Policy Details
:13140044210700000432 Business Source Code
Policy Nuber DIRECT (1D13699639)
Period of Irsurance :From:13/09/2021 12:00:01 AM To: Dev.Off. levelVBroker/Corp. :|
12/09/2022 11:59:59 PM_ Agent
Date of Proposel :13-Sep-21 Agent/Bancassurance/CPS:Mr. MR. GIRISH V. SHAH
(NIAAGO0112673) MR. GIRISH V.
C User
SHAH (SI00182591)
Phone No 9930305358 / NA
Prev. Policyo :13140044200700000277
: Non-Corparate E-mailFaxX
Clert Type
Financier(s) Details
SL No. Name ofthe Financiers
TATA CAPITAL FINANCIAL SERVICES LIMITED
Total Receipt No. &Date
Premium GST 13140081210000005676-
2238 14676
12438 06/09/21

Location of Operation
MAHARASHTRA, INDIA, 400601
Locatiors of Operation Risk Address: 1 ANYWHERE IN, INDIA, THANE,
Speciñcation Of Insured ltems
Description of ltemss Year of SumInsured Escalation(| Excess due Excess due Excess for
EmQuantiy
Manufacture (In ) %) toAOG to Other |Boom Section
NO (Ype, Manutacture, Perils than AOG
Capacity) Perils
10 84245.28 84245.28 20% of claim
2015 8424528
Machine Description: amount
HAULOTTE AB HA Subject to
260PX AERIAL WORK | minimum of
PLAIFORM 25000/-
ARTICULATED DIESEL|
BOOMLFT, EQ ZONE-I|
COVERED, FLOATER
BASIS.,Name of the
manutacturer.
HAULOTTE,Machine
Senal Number: AD-
L2I242

Total Sumlnsured R8424528

Kcess
Add on Covers Opted Indemnity Limits Opted
SI. No. 842452 Policy Excess
THIRD PARTY LIABILTY Policy Excess
NA
EXPRESS FREIGHT (EXCLUDING AIR FREIGHT),
HOLIDAY RATES OF WAGES ETC
NA 5 %of Air Freight
AIR FREIGHT

38400 at 06/09/2021 17:56:12 Hours.

Policy No. 13140044210700000432Document generated
by
No. 1 800 209 1415.
India Assurance Bldg. 87 M.G. Road, Fort, Mumbai -400 001. TOLL FREE
Regd. & Head Ofice: New
 NA
18-02-2022
19-08-2021

CE
MA204O2
45.16% AD 127

01/10
RACHNA POLLUTION TESTING CENTER

OR- 01
Vehicle Pass.

POLLUTION UNDER CONTROL CERTIFICATE

(Under rule 129 A (1) ofimv Rule 1993)
CENTER
RACHNA POLLUTION TESTING
JHARSUGUDA
BOXI CHOWK,IN FRONT OF R.T.OFFICE

Test Station Code: 01

Label Code: OR 01/10

Vehicle Reg No: NA

PUCC No: OR010021030

SHAKTI EQUIPMENTSP LTD HMV

Name: Category:
HAULOTTE
THANE Make:
Address: ARTICULATED
THANE Model:
Date of Reg.: 2015
MH
Speedo mtr Rdg: 780
Date:19/08/21
Engine No: 0
Time: 3:00: PM
Chassis No.: AD 127242
Fuel DIESEL

Min:00075 RPM Ma02504

Flushig Cycle Mean: R PM

SNo. RPM min RPM max Km-1 HSU % OTP C

1,00154 1624 1.45 18.2 ,0030
1327 1.45 18.25 ,0033
,00387
1458 1.45 18.25 ,0035
00348
4 ,00396 1855 1.45 18.25 ,0037
Valid upto:18/02/22

Grade: A

Test Fee:150

Mean ,00369 1812 1.45/m 18.25% ,0038

Prescribed under Rule 115(2) of Central Motor

This vehicle meets Emission Standards
Vehicle Rule's 1989.

Authorised Signatory
Seal of Testing Centre
INDUS DiesX 2.06/0307-0002/5441
 Certlicate of Conpletiou CESL TRA1NTNG

Certificate Number - CESL- Q0127/011/2021

PADUR
MR. SHYAMA YADAV
Has sucessfully fulfilled all the theoretical and practical training and
evaluation requirements listed in NSDC curriculum of training and regulations (IES/Q0127)
and has thus completed Aerial Work Platform Operators training program
Date of Issue: 27-09-2021 Date of Expiry: 26-09-2022

Dr. Krishnan Sampath

CEO Capital Equipment Services Limited

N.S.D.C
Nalional ISO
Levelupmmrt
IESC Skill India Corporation FOR SAFETY
Netkona sa ty Counc
18878 2013 Mambernhp No: CM TN1089
27/141 20:1C13 1807

www.ceslindia.com
 O/21, 3:07 PM
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1:07 PM M

Update Virtual DL

DL
SHYAMA YADAV
Active

NEVAS YADAV

Sep 20, 2019

Sep 19, 2029

Aug 07, 1973 Ot

Vehice Ciass
CRANE

OD34 RTO,JAJPUR

Tap to Check the Drivinig Licence Impound &

Seizure Document Status

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generated by mParivahan as per dataprovided by
the issuing authority in the National Registry of
Ministry of Road Transport and Highways.,

This document is valid as per the 1T Ad

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 1634716375897.jpg
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1:06 PM

DL Dashboard

OD3420190005921
SHYAMA YADAV
C/O-SUJIT KUMAR MOHANTY, AT KANHEIPUR JAJPUR
ROAD JAJPUR, JAJAPUR ROAD
,JAJAPUR ,OD
EIssue Date Sep 20, 2019 Valid Till Sep 19, 2029

anivalgam GOV.M

A
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 NDA ODISHA STATE
OD34 20190005921

Number
SHYAMA YADAV
Name

NEVAS YADAV
S:DW of
MOHANTTY
KUMAR
CIO- SUJIT J A J P U R ROAD
Address AT
KANHEIPUR

JAJPUR JAJAPURROAD
JAJAPUR,OD 755019

issued on 20-09-2019
07-08-1973 B6 0+VVE
DoB

Vehicie Ciass CRANE

Cate o i s s u c 20-09-2019
Vaic tli t Transpot
19-09-2029
i a cNon-Transport)

ri
 LiL

Jepur
C.H..

"qrgyaMG"

SGi2 6 1CN
 RC/DL STATUS
21/21, 2:08 PM
AA A

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SEWA
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OD-3420190005921
Details Of DrivingLicense:
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SHYAMA YADAV
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Source Of Data SARATHI

Driving License Initial Details

Initial lssue Date 20-Sep-2019

RTO,JAJPUR
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cOV Category Class Of Vehicle
COV Issue Date

NT CRANE 20-Sep-2019

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 Good condition
Over Reach Limit Switch
Switch Working
Siren acctiivation before activation of Limit Working
Safe Load & Over load Indicators
(d) Good condition
(c) Operating Panel at ground Good condition

() Operating Panel at Platform Good condition

i.e., arrangement for preventing fall of Man
(g) Satety gear, Good condition
(h) Brakes Good condition

() Hydraulic Boom jacks Good condition

condition
) Boom general Good condition
Platform general condition
(k) Good condition
() Prime mover Internals of Engine and Hydraulx
inaccessible
11 What parts (if any) were
Mechanism
examination
Nil at the time of
renwal or alteration (if any) required and the period
12 Repairs,
within which they should be executed.
The deflected boom
13 Load Testing Platform was loaded with 454 kg.
(a) Static Tests At Ground level the The lifting cut off at
230kg
after unloading.
returned back to original position
Motions were smooth.
All movenments were tried with 230kg.
(b) Dynamic Tests there was no sign of amy

With the above load and

while performing all operations,
(c) Stability Tests
instability. Nil at the time of examination
load found
14 Particulars of any defectsaffecting the safe working of the
after annealing and
at any such thorough examination or
steps taken to remedy such defects: materials subject max of 180kg.
2 of Persons + operator/few
15 Maximum Safe nos

should be er

Working Capacity The equipment should not be oprated without a

traincd operator. The operato
be operated on farly
levelled hard
Others at any cost. The machine to
vigilant, not overload
the platform at SiWL 1e|
to be tested for smooth uorking
into use the equpment
ground. Every day before taking
with 230kg material.
the extent
the above MAN LIFT
was thoroughly cleaned to
I certify that on 3-Jul-21 to asceriain the
health of
and for such tests as were necessary
examination
possible for
amd made accesible thorough and that the above is a
correct report of tihe result.
examined this MAN LIFT
MAN LIFT. I have thoroughly
the above
Person sbject 30-Dec-21
examination to be conducted by Competent
Next due datefor to SOP&SMP

Y a a s a a l Alai
Signature
Qualification: B.Tech (Hons).Competant Parthasarath Dalal,B.Tech
55(G)
Person Recgn. No: CP(O)NO
Address:PlotNo:1205/A.P.O:Nayapalli,
CompelantPerson
Bhubaneswar 751012. Fegd Na:-CP (0} No-55(G)
3-Jul-2021
Date: 3-Jul-21
HAULOTTE -

HA80-7242/TC 1 Y1H1
PSD/2021/MEWP/TSL-MICCO/

MWEP
EXCEL FILESISTD MANLIFTISTD MANLIFTS page of 2
STD REPORT
D:1Comp Person Work15. SHAKTI.xlsx
HAULOTTE- HAB0 227242-
TATA -