[regs 5(3) & (5)] [OUR 503) (5) Certificate No. BuseR CERTIFICATE OF TEST AND THOROUGH EXAMINATION OF CRANE, CRABS AND WINCHES Form approved by the Commissioner for Labour for the purposes of regulation 5(3) de (S) ofthe Factories and Indusrial Undertakings (Lifting Appliances and Lifting Gear) Regulations IRR LHS RRR Re SRA BEE CARE RRENMRRMERRERE BS ARABI RAL RTGS CRA RL SM) MH 5(3) (5) GMM LT 1, Name of owner and address of installation of the appliance AEE RRO Be tA 2, Name and address of maker of the appliance PMS AER ht 3. Type of appliance and nature of power (e.g. Scotch derrick-manual; tower derrick- electric; rail mounted tower-electric) RUT RATE DONO + SMT AFR — An ERASER — 2): REMNEHSAREM — 1H) 4, Date of manufacture of the appliance ROLE 5. Identification (a) Maker's serial | “number number aaa Rs Ri (b) Owner's distinguish- ing mark or number (if any) ARR EA Rs mR Re) LALG-F3+16. Safe working load or loads. a @ @ @ In the case of a crane with a variable operating radius (including a crane with a derricking jib or with interchangeable jibs Safe of different lengths) the safe working load at | Length. Radius Testload | Working various radii of the jib, jibs, trolley or crab | of jib (metres) (tonnes) load must be given; test loads at various radii | (metres) ee ‘mIBRA A (tonnes) should be given in column (3) and in the | Berea | GukBM) | AAw | SERRA case of a safe working load which has been | (LASS R(t) OAR ALD | (LON A) calculated without the application of a test load “NIL” should be entered in that column, ERAT RO BRR ORE ES ESS CRAASARRATAREA RST RRR) » UATE Hs Bee HERRERA SPER HOE Rei > MRS RSE MY ARTS GMA LO SME A TE A STOMA + PURER RES ee 7. In the case of a crane with a derricking jib or jibs the maximum radius at which the jib ot jibs may be worked (in metres). MRRERRERAL RRR > MEAT RRR ERR OPM LKR MIL 8. Defects noted and alterations or repairs required before appliance is put into service. If none enter “None” and state whether in safe working order. EON FSBO Es Bw TERS RSH © OAS > AIT HE FRERR EAE SRS ° 9. In the case of a crane, state whether the automatic safe load indicator is in good working order. AEORRRES EARRHZE AA SORT SR SRLS MERE + Thereby certify that on ....... se Woes the appliance described in this certificate was tested and EBBKAGE—A a B BRA BAe 1 GALE A Ee a a TIO thoroughly examined by me in accordance with the First Schedule and that the above particulars are correct. BR BLAS Bie ° LALG-F3-2Signature of Registered Professional Engineer HBSS EMSS Qualification .... nae Discipline EAR ‘Name and address of person, company or association by whom the person conducting the test and examination is employed ME BUTERA RRR AL + 2] RR AE SCE AB AL Date of certificate ... SS Any competent examiner or competent person who delivers to an owner a certificate or makes a report which is to his knowledge false as to a material particular shall be guilty of an offence and shall be liable on conviction to a fine of $200,000 and to imprisonment for 12 months. FOSHRBRRARENA NOME TH RSM RS ARS CE BE ME LAA SS» OBIE | GER + SORA + wT BE LALG-F3-3