DESIGNER STATEMENT

I declared that the plant being registered (Name of Plant: xxxxxx) has incorporated
the following standards and engineering principles in its design:

AS1210:1997 Class 3

I have complied with the designers obligations under Section 22 of the Work Health
and Safety Act 2012 (SA) in respect to the design of the plant.



Print Name _____________________

Signature _____________________

Date __________________________