You are on page 1of 1

Page 1 of 1

1*

REPORT OF A THOROUGH EXAMINATION


OF LIFTING EQUIPMENT
2*

date of issue

unique identification / Certificate Number,

2*

13 Sep 2015

DAC/GM/130915/006

IB-053

This Report complies with the requirements of the Lifting Operations and Lifting Equipment Regulations 1998
22 Measuring units (for Loads / Weights) shall be in either/both Metric kilograms or pounds
3* Identification of the issuing IB Name and address of the IB issuing / endorsing the
4* Identification of the client Lifting equipments Owners/ Contractors name and address,
certificate,
KTL Offshore ME FZC, Plot 2M-09. Hamriyah Free Zone PO Box 42452, Sharjah, UAE
KTL Offshore ME FZC, Plot 2M-09. Hamriyah Free Zone PO Box 42452, Sharjah, UAE
7 The address of the premises at which the Inspection was made,
5* Description of the inspection work ordered,
KTL Offshore ME FZC, Plot 2M-09. Hamriyah Free Zone PO Box 42452, Sharjah, UAE
Annual Certification of lifting equipment.
6* Date(s) of inspection and Type of Inspection,
8 Manufacturer or Supplier of equipment name and address,
13 Sep 2015, Visual and Dimensional Inspection of Lifting Gear with DAC required 6
monthly SWL test.
9* Identification of the object(s) inspected and, where applicable, identification of the
10 Unique Identification Numbers, brief description and SWL of the equipment,
specific components that have been inspected and identification of locations,

CROSBY

SN. KIM EAR 196


11 Any reservations or restrictions on the use or Maximum Capacity of the equipment,
Nil.
13* Identification or brief description of the inspection method(s) and procedure(s) used,
mentioning the deviations from, additions to or exclusions from the agreed methods and
procedures,
Visual and Dimensional inspection referencing:BS EN 818-1
14 Identification of equipment used for measuring/testing,
Caliper Serial Number KTL-003 Calibrated on 7th Nov 2015
Measure Serial Number KTL-002 Calibrated on 7th Nov 2015
15 Where applicable, and if not specified in the inspection method or procedure, reference
to or description of the sampling method and information on where, when, how and by
whom the samples were taken,
Nil.
17 The Due date of next Thorough Inspection,

Immediately after repair


19 Applicable Reference Standard / Code,
BS EN 13157
Reason for Test

Chain Sling
WLL 7.5 t
GRADE 80

12* Information on what has been omitted from the original scope of work,
Nil.
Test Load Applied and duration held (as applicable)
Nil
KTLO (ME) FZC PO, DO, SO information
MESO Surveillance Visit 2015
16* If any part of the inspection work has been subcontracted, the results of this work shall be
clearly identified,
Nil.
18 The Due date of next Proof Load Test, if applicable,
Not Applicable / At surveyors discretion
20 Details of any major Repairs / Alterations carried out on the equipment, provided that the
clients inform IBs inspector of any modifications or structural repairs,
Nil.

In accordance with written inspection scheme and recommendation from previous inspection reports.
Was the examination carried out:

Is this the first examination after installation or


assembly at a new site or location

YES

NO

Within an interval of 6 months?

If the answer to the above question is YES has


the equipment been correctly installed

YES

NO

YES

Within an interval of 12 months?

YES

In accordance with an examination scheme

YES

After the occurrence of exceptional circumstances

YES

NO

NO

NO

NO

Identification of any part found to have a defect which is or could become a danger to persons and a description of the defect: (If none state NONE)

Missing Safety Latch on both Hooks.


Is the above a defect which is of immediate danger to persons?

YES

Is the above a defect which is not yet but could become a danger to persons? (If YES state the date by when)

YES by: Immediate

N
O
N
O

Particulars of any major repair, renewal or alteration required to remedy the defect identified above:

Install new safety latch on both hooks as per OEM specification


Particulars of any tests carried out as part of the examination: (If none state NONE)
NONE

IS THIS EQUIPMENT SAFE TO OPERATE?

YES

N
O

21 Details of latest Inspection / Tests previously performed including any NDT if possible,
Visual inspection & rated load test as per KIM EAR 196
23 Information on environmental conditions during the inspection, if relevant,
Not Applicable.

Previous inspection test reference (cert number)


KIM EAR 196
24* the results of the inspection including a declaration of conformity and any defects or other
non-compliances found (results can be supported by tables, graphs, sketches and photographs),

28* Names (or unique identification) of the staff


members who have performed the inspection

29 Name, Signature, and Designation of signing


Authority of IB, (if different than the inspector
who performed the test)

FAIL Unacceptable to Specification


Gaudenfel Mahinay
Name
Signature

13 Sep 2015
Date

27 The inspector's mark or seal, if any,

Company Stamp

S Morrison
TS Manager
Name

13 Sep 2015
Signature

Date

Company Stamp

26 The inspection certificate/report shall not be reproduced except in full without the approval of the inspection body and the client,
The Certificate / Report becomes invalid, if any alteration/major repair / modification made upon the equipment described herein, in which case it must be re-examined and re-tested.
30 This certificate is issued subject to the condition that it is understood that nothing herein contained shall be deemed liable to relieve
any designer, manufactures, seller, supplier, repairer or operator of any warranty, express or implied and KTL Offshore (ME) FZC liability
shall be limited to the acts or omissions of its employees, agents and subcontractors. Under no circumstances whatsoever shall KTL
Offshore (ME) FZC nor their engineer be liable for any damage to any person or occurring by reason of negligent operation or defects in
materials, machinery, equipment or other items than such defects ascertainable by normally accepted standards and only those items
actually inspected by KTL Offshore (ME) FZC and which are only covered by this certificate. Any person not a party to the contract
pursuant to which this document is delivered may not assert claim against KTL Offshore (ME) FZC for any liability arising out of errors or
omissions which may be contained in this said document and in connection with any activities for which it may provide. This certificate
shall not be reproduced in full without the approval of KTL Offshore (ME) FZC.
ISO17020
ISO9001:2008

KTLME-FORM-TS-005B