م.م.
الــفـــريــــق الســتــشــــارات الســـالمــــة ذ
TEAM SAFETY CONSULTANTS L.L.C
004-IB
CERTIFICATE OF EXAMINATION AND TEST OF BUMPER CAR
Job No: Certificate No:
Name of Owner
Address
Type of Inspection
Name of Manufacturer
Serial / ID Number
Numbers of Cars Permitted in
Device
Year Manufactured
Name of Operator
Overhead System Dimensions
Floor Pick-up Dimensions
Car Dimensions
Date of Previous Test: Date of Inspection: Date of Issue: Date of Expiry:
TSC Test Method No: TSC Test Equipment No: Standard Reference & Regulation:
,BS EN 13814, BS EN 12572
TSC/ITP/26 TSC/EQ/ 05, 07, 10, 16, 17, 29, 35 ASTM F2974, ASTM F846
*This Certificate becomes invalid, if any Alteration / Repair & Modification are done.
THIS IS TO CERTIFY THAT the Undersigned, a competent representative, did, attend to examine the item described herein in accordance to the aforementioned standard.
At the time of examination the said item were found to be free from crack, flaws, deformation or other defects. 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. Mark Victorino Eng. Abdul Aziz
Inspection Engineer Technical Manager
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-17S (Rev.08) (28/01/2023) Page 1 of 1
,TEAM SAFETY CONSULTANTS L.L.C, TRADE LICENSE NO. 500714, AL-GARHOUD, P. O. BOX: 112349, DUBAI -UAE
/TEL: 04-2828868,FAX: 04-2865265 EMAIL:
[email protected], WEBSITE: https://www.tsc-uae.ae
Continuation of Job No.: Certificate No.:
FINDINGS SECTION
Findings Target Date:
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.
Note:
a. 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.
b. 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.
c. This is the client responsibility to adhere the supplementary points at all the time but not limited.
TSC-F-17S (Rev.08) (28/01/2023) Page 2 of 1
