‫الــفـــريــــق‬

‫الســتــشــــارات‬
‫الســـالمــــة‬
004-IB

TEAM SAFETY CONSULTANTS

CERTIFICATE OF EXAMINATION AND TEST OF ELEVATOR

Job No.:
Type of inspection
Certificate No.: ELE/

Client Name

Address

Equipment ID Type of Driving Machine

Manufacturing Number No. of Stop/Floor Served

Make Type of Door

Year Manufactured/Installed Suspension Details

Usage Rated Speed

Attending Maintenance Company Rated Load & No. of Persons

Date Of Previous Inspection & Test Date Of Inspection & Test Date of Issue Next Inspection & Test Due On Or Before

TSC Test Method No. TSC Test Equipment No. Standard Reference & Regulation

TSC/ITP/06 TSC/EQ/05, 07, 13, 17, 20, 21, 28 BS EN 81 – 20 : 2020; BS EN 81 – 50 : 2020

*Certificate becomes invalid, if any alteration/major repair/modernization made on the Elevator in which case it must be re-examined and re-tested.

THIS IS TO CERTIFY THAT the Undersigned, a competent representative, did, attend to examine this equipment in accordance to the aforementioned standard to
ascertain its safe working load and that the examination indicated that the said equipment has no indigenous injury or sighted deformation and the safe working load of
the said equipment as either identified or test proof loaded is shown. The equipment is satisfactory for its intended use within the limits specified and at the time of
inspection was found to be satisfactory for further use, provided there is continuous maintenance applied, implementation of our remarks & recommendations and
qualified operators employed.

Name and position of person who Authorized signatory authenticating

carried out the inspection and test: :this certificate

Eng. Umar Nazurudeen Eng. Kunhi Krishnan

Inspection Engineer Dy. Senior Inspector

CERTIFICATE is granted subject to the condition that is understood and agreed that nothing herein contained shall be deemed to relieve any designer, manufacturer,
seller, supplier, repairer or operator of any warranty, express or implied. This inspection is not intended as guarantee against failure or malfunction. Team Safety
Consultants will not be held responsible for any damage to the equipments or parts after examination or accident due to improper use. No liability for use, operation and
for any hidden defects or information related to the equipment and inspection done is assumed by the inspector or Team Safety Consultants. Any person not a party to
the contract pursuant to which this document is delivered may not assert claims against Team Safety Consultants for any liability arising out of errors or omissions which
may be contained in said document and in connection with any activities for which it may provide. This certificate shall not be reproduced except in the full without
written approval of the Team Safety Consultants and the receiving client.

TSC-F-17E (Rev.04) (05/01/2022) Page 1 of 2

TEAM SAFETY CONSULTANTS, TRADE LICENSE NO. 500714, AL-GARHOUD, P. O. BOX: 112349, DUBAI - UAE, TEL: 04-2828868, FAX: 04-2865265
EMAIL: info@teamsafetyconsultants.ae, WEBSITE: http://tsc-uae.ae/

Continuation of Job No.: Certificate No.:

FINDINGS SECTION
Findings Target Date:

A. The following items found that needs to be rectified and/or arranged:

1.

B. As there was no requirement to a specific reference standard during the installation stage and the existing elevator was
installed in accordance to the approved manufacturer standard specifications only. Upgrading the safety level, referring to
the current standard BS EN 81, it is recommended to consider the implementation of the following in medium term or
together with major modernization:

1.

Supplementary:
a. Periodic maintenance required as per the manufacturer instruction.
b. If any abnormal condition / sound observed from the equipment during the time of operation, the concerned person should be informed to the maintenance provider, client, building
maintenance and safety personnel.
c. Lifting hook in machine room / lift well shall be tested before use.
d. Trained manual rescue personnel shall be available at site all the time.
e. Building management shall comply the fire detection & sprinkler systems installation requirements.

Note:
a.Certificate becomes invalid in case of any major repair, modification and/or alteration on the design of the equipment; in which case it must be re-inspected and re-tested.
b.It is imperative that action be taken on the items mentioned in the subsequent pages and provides continuous preventive maintenance according to maker’s instruction.
c.In accordance with EIAC-RQ-IB-001, conditional based validity certificate is issued, Certificate become invalid in case of not rectify the finding within target date, in which case it must be
inspection again.
d.This is the client responsibility shall be respond / inform to TSC for the Re-inspection or submit the evidence within the target date given in the inspection certificate.
e.This is the client responsibility to adhere the supplementary points at all the time but not limited.

TSC-F-17E (Rev.04) (05/01/2022) Page 2 of 2