Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

Regional Office No. ___

PERMIT TO OPERATE STEAM BOILER

(This permit is valid only upon payment of inspection fee and expires one-year from date of inspection unless otherwise revoked)

DL No. Date of Inspection:

Pursuant to Article 165, Chapter II, Book IV of the Labor Code of the Philippines (LCP), as amended and
its implementing rules and regulations. Rule 1160 of the Occupational Safety and Health (OSHS), as amended, it is
hereby certified that herein described boiler, inspected by the duly authorized representative of the Department of
Labor and Employment has been found to be in condition safe for operation at a pressure not to exceed ______
psig.
Name of Owner/User
Location of Boiler
Type and Kind of Boiler
Date Make
Boiler Brand Name or Manufacturer
Place of Origin
Horsepower Rating
MAWP
Thickness of shell and size of Boiler

Inspection Fee P
Official Receipt No.
Date

Regional Director
(Please post this permit in a conspicuous place enclosed in a glass frame and accessible
to all concerned inspecting authority)