TSA-9

Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No. _________

APPLICATION FOR CRANE AND HOIST INSTALLATION

1. Name of Establishment:_____________________________________________________________________
2. Complete Business Address: __________________________________________________________________
____________________________________________________________________________________________
3. Owner/Manager and Address: _______________________________________________________________
____________________________________________________________________________________________
4. Where Crane is to be installed: _______________________________________________________________
____________________________________________________________________________________________
5. Plans to be submitted: submit (in quadruplicate) the foundation plan with design, working
drawing of the crane and hoist installation and location plans of the unit involved. 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 plant.

6. Crane Machinery Data:

a. Manufacturer: _______________________________________________________________________
b. Type and Model: _____________________________________________________________________
c. Serial Number: ______________________________________________________________________
d. Place of Origin: ______________________________________________________________________
e. Date of Make: _______________________________________________________________________
f. Power System: _______________________________________________________________________
g. Safe Work Load: _____________________________________________________________________
h. Lifting Speed: Main Hoist: _____________________________________________________________
i. Auxiliary HOIST; _____________________________________________________________________
j. Standard Hoist: Traversing Speed - High Speed: ___________________________________MPM
- Low Speed: __________________________________ MPM
k. Total No. of Motors:____________________; Total HP/KW of Motors_______________________

7. Printed Name and Signature of Person

to Supervise the Installation: ______________________________________________________
PME Registry No. ______________ Date: __________________
PTR No. ____________________ Date: __________________
TIN: ______________________________________________

8. Other accessories or equipment: _______________________________________________________________

______________________________________________
Printed Name and Signature of Owner/Manager
Company TIN: ___________________________
Company Tel. No.:

Application No. _________________________________________