Thorough Examination Certificate For Power Tools/machines

Company Name: Keilani Construction Co- Contact Person Bassman Contact Number 0558270535
llc
Project Name Idx21 Location Abu Dhabi, Inspector Name Ahd Ezzat Oreg
Mussafah
Inspection Item Jack Hammer Inspection Date 2024-02-15 Date of Expiry 2024-08-14
Certificate Number USHC-21519 Type of Inspection Periodic Inspection Status Safe
Test Report NO. UrTS-11108 Revision 0 Workorder 5878
Power Tools/Machine-Description
Type of Tool/ Machine Jack Hammer Manufacture AFF Model AF-DM1212D
Quantity 1 Serial number(s) KCL-010 Additional information NA
Remarks NA Previous inspection date NA inspection equipment's MT37, DC27, LDM01
References Provision And Use Of Work Equipment Power supply description Voltage: 240v
Regulations 1998 (PUWER) Frequency: 50-60Hz
Defects
defect description NA
All the inspections results relates exclusively to work ordered or objects or lot inspected and inspection certificates/reports shall not be reproduced except in full without approval of inspection body
and the client. Urban has legal indemnity against all losses, accidents and damages on site arising due to faulty inspection activities during the work. we certify on behalf ofURBAN SAFETY &
HEALTH CONSULTANCY that the item(s)/equipment described in this certificate is/are
Safe TO USE
and that the particuler details are correct. Urban is a third party inspeciton Type A Inspection Body

The item/equipment should be re-tested in case of any major repair and/or althernation at the above details/description.
Please note that Below Signature & Stamping are generated & Approved Electronically.

Inspection Engineer Technical Manager

ENG. Ahd Ezzat Oreg ENG. Danial Naseer

ENG-CR-55/V4/2021-01-21
Tel : +971 2 558 32 45 FAX: +971 2 558 32 44

E.MAIL : info@urbansafetygroup.com - Abu Dhabi - Al Mussafah - M-44

www.urbansafetygroup.com
 Inspection Details

Power Tools/Machine Checklist Summery

Body Condition Safe
Locks/ Nut-bolts Safe
Electrical Cords/Air Hoses/ Connections Safe
Guard-Shield for moving parts Safe
Documents/ Markings Safe
Function Safe

In providing services information or advice URBAN SAFETY & HEALTH CONSULTANCY does not warrant the accuracy of any information or advice supplied by the end user , and shall not be
liable for any loss, damage or expense whatever sustained by any person due to any act of mis-operation/ mis-handled.
It should be also understood and agreed that all contained information in this report shall not be considered to relieve any designer, manufacturer, supplier, seller, repairer or operator of any
warranty, expressed or implied.
URBAN SAFETY & HEALTH CONSULTANCY will not support the validity of any certificate if it has been found that the item descriped has been mistreated, overloaded, impact loaded,
misoperated, misused or shock loaded.
This certificate is the property of URBAN SAFETY & HEALTH CONSULTANCY and shall be retuned on demand.
THIS REPORT HAS BEEN ISSUED WITHOUT PREJUDICE TO ANY PARTY INVOLVED

ENG-CR-55/V4/2021-01-21
Tel : +971 2 558 32 45 FAX: +971 2 558 32 44

E.MAIL : info@urbansafetygroup.com - Abu Dhabi - Al Mussafah - M-44

www.urbansafetygroup.com