TEAM SAFETY CONSULTANTS

CERTIFIED MANAGEMENT SYSTEM

CERTIFICATE OF ASSESSMENT This is to certify that:

Mr. DARSHAN S.K.SINGH

Nationality : INDIAN Driving License No. : 2078296 Company : NATIONAL PROJECT CONSTRUCTION Test Equipment : ASSESSMENT OF BACK HOE LOADER OPERATOR Date : 18 / 03 / 2014 Certificate No. : BL/C4 Job No. : AD0019
S. No.
1 2 3 4 5 6 7 8 9

Parameters
Experience as Operator Physical Health Condition Knowledge of Equipment Safety Operation of Equipment Safety Awareness Equipment Inspection Equipment Operation Theoretical Practical

Good

Fair

Poor

Not Applicable

Has successfully completed one day site assessment on safe operation of BACK HOE LOADER. Note:
* In case of any physical disposition of the operator, or any changes in the working condition, re-assessment is required within the stated period.

* This certificate is only proof of competence of the person on the above date.
* Safety Orientation Program. Name and position of person who carried out the Assessment:

Eng. ROOPESH YESHODHARAN Instructor / Tutor TEAM SAFETY CONSULTANTS (TSC) APPROVALS: Approved by Labour Ministry Approved by Dubai Municipality Overseas Associate Member of Lifting Approved by Abu Dhabi Municipality Approved by Dubai Civil Defense Approved by Jebel Ali free Zone Equipment Engineers Association (LEEA) UK THIS CERTIFICATE IS VALID FOR ONE (1) YEAR FROM THE DATE OF ISSUE

AS PER THE CODE OF CONSTRUCTION SAFETY PRACTICE TEAM SAFETY CONSULTANTS, MUSSAFAH ABU DHABI, P.O.BOX 29254, UAE, TEL: 02-5548383, FAX: 02-5545463, E-mail: tscon@emirates.net.ae, Website: www teamsafetyconsultant.com
TSC AEO-1A (rev. 04) (18/03/2014)