INSPECTION CERTIFICATE OF LIFTING APPLIANCE

This report complies with the requirements of the BS standards

Test Engineer report:

Work No: DT-20- Certificate No:
Details of Owner of the Lifting appliance / Customer Details:
Details of the Manufacturer/Supplier of the Lifting appliance :
Site Location:
Inspection Requested by:
Nature & Type of Inspection:
Initial /Periodic / Major
Details of Previous Inspection and Test:
Reference Standards: BS EN 14502-1:2010 / DUBAI LOCAL ORDER # 61 / 1991
Test Method Used: DT-IP-13
Dubai Local Regulation # 2/2010
Local Regulations:
Dubai Municipality (EIAC-RQ-IB-001) -(EIAC-RQ-IB-002)
Test Equipment Details:
Defects noted and alterations or repairs required before is put
into service (If none enter “NONE”)
Date of Test and Examination: Date Due and Validity:
Distinguishing Safe working Proof load if
Number or Description of item load, SWL applied Remarks
serial Mark (ton) (ton)
MAN BASKET

Make :
Model :
Overall Dimensions :

No of lifting points( pad eyes) :

Pad eye hole diameter & thickness:
Empty weight :

NOTE: The validity of the certificate 06 months ceases in the event that any repair or alteration made, in which case it must be retested.
The inspection certificate/report shall not be reproduced except in full without the approval of the inspection body and the client.
We, Dutech Safety & security Consultancies, Dubai, certify that the below particulars are correct and Lifting equipment’s described herein is
inspected and tested by a competent person, according to BS Standards. At the time of inspection the Equipment has been found to be free from
any adverse qualities that can affect it’s safe to use and it is safe for its intended use. Please see the recommendations detailed report overleaf.
Inspected By: Verified By:

(Signature) (Signature)
NISARUDEEN RETHEESH REGHU
(Inspection Engineer) (General Manager)
The certificate is issued subject to the condition that is understood and agreed that nothing in the report shall be deemed to relieve any designer,
manufacturer, seller, supplier, repairer or operator of any warranty, expressed or implied, and Dutch Safety & security Consultancies shall be
limited to the acts or omission of its employees, agents and subcontractors. Under no circumstance whatsoever shall and Dutech Safety &
security Consultancies be liable for any injury or damage to any person, or occurring by reason of negligent operation or any defect in materials,
machinery, equipment or other items other than such defects ascertainable by normally accepted testing standards and those items inspected by
Dutech Safety & security Consultancies and which are covered by this certificate.

Page 1 of 3
Doc. No: FM-DT-59-1 REV 03 Dated 19-07-2020

Po: Box: 390500, Al Qusais Ind. Area 2, Dubai, UAE.

Tel: +971 42568979, Email: dutechsafety70@gmail.com
 Test Engineer report:
Work No: DT-20- Certificate No:
EXAMINATION & TEST REPORT OF LIFTING APPLIANCE

CHECKLIST FOR MAN BASKET

ITEM DESCRIPTION
OK FD CFD NA
DOCUMENTS VERIFICATION:
1 Declaration of conformity (or) Previous inspection certificate
2 Mill certificate of steel (or) SWL design calculation available
3 Maintenance log sheet
4 Mfg. Manual & technical instruction
5 PPE (Inspector / Operator)
6 Personal Certification Operator
MECHANICAL STRUCTURE:
7 Marking / hard stamping of SWL and MGW
8 Minimum standing height of 2 m
9 Pad eye assembly
10 Welding condition
11 Bolts, hinges, rubber sealing are secured
12 Pad eye hole (smooth & efficient, no wear, undue elongation or physical damage)
General structure (Condition for deformation,
13 Distortion, cracks or damage)
14 Pitting or general corrosion underneath
15 Supporting members
16 Floor condition
17 General paint status
18 Hand rail
19 Door installation & lock
OTHER ACCESSORIES
20 Check associated sling assembly if any
21 Load lifting attachments
22 NDT inspection if required
23 Torque verification for all bolts
24 Warning sign
25 Safety instruction
LOAD TEST:
26 Load test (as per the manufacture/ LOLER)
27 Evidence files (photos, manufacture details, etc.) shall be attached with checklist
OK- SATISFACTORY FD- FINDING CFD- CRITICAL FINDING NA- NOT APPLICABLE
General Notes/Remarks/Recommendations (If any)

Any reservations or restrictions on the use of Maximum Capacity of the Equipment:

Note: Please rectify the remarks / recommendations given in the above column.

Inspection Engineer: Company Seal:

Page 2 of 3
Doc. No: FM-DT-59-1 REV 03 Dated 19-07-2020

Po: Box: 390500, Al Qusais Ind. Area 2, Dubai, UAE.

Tel: +971 42568979, Email: dutechsafety70@gmail.com
Date:

Page 3 of 3
Doc. No: FM-DT-59-1 REV 03 Dated 19-07-2020

Po: Box: 390500, Al Qusais Ind. Area 2, Dubai, UAE.

Tel: +971 42568979, Email: dutechsafety70@gmail.com