Report No.

We hereby certify that the item in the following was tested by our Inspector

Owner:

Item:

Place of test: Date of test:

Make/Type: Model:

Manufacture: ID No.:

Scope of Inspection and Testing:

The following tests have been carried out on the equipment:

1. Visual Inspection

2. Functional and operational test

3. Temperature Measurement for engine surface and exhaust

4. Witnessing of the over speed cut off RPM

Result(s) of Inspection and Testing:

1. Visual Inspection of the equipment : In Order

2. Operation and functional test of the above equipment : In Order

3. Temperature survey carries out for engine surface and exhaust gas : Measured

4. Witnessing of the over speed cut off RPM : Measured

Conclusion:
- Operational Test and functional test of the above equipment was carried out & was in order at the time
of inspection.

- Performance of the above unit was found to be in order during test.

Date of Next Inspection :

(Place & Date) (Inspector to DNVGL)

(cont...)
Page 1 of 2

LIABILITY:
The client or his assignee agrees to indemnify and hold harmless DNV GL from and against any and all claims, demands, law suits, or action for damages ,including
legal fees to person and/or property tangible, intangible, or otherwise which may be brought against DNV GL incidental to arising out of or in connection with the work
to be done, services to be performed or material to be furnished except for those claims caused by solely and completely by the negligence of DNV GL or it’s inspectors.
Report No.:

PART 1
Name and Address of the Owner:
Equipment:
Date of Inspection:
Win No. (if applicable):
Make and Type:
Mobile or Skid Mounted or Towed:
Serial No.:
Will be used for:
Registration No. (if applicable):
Day or night:
Engine Details:
Make and Type:
Diesel Engine Only:
Serial No.:
Cooling System (Air or Liquid):
Air System (normal or turbo charged):
Firing System:
Two or four Stroke:
Starting System (manual or electrical):
Horse Power or Kw:
At revs. Per minute:
No. of cylinder:
Is Spark Arrestor fitted:
Is Antistatic belt fitted:
Is Chalwyn valve fitted:
Is Emergency stop switch fitted:
Is Battery Isolator fitted:
Is dry powder fire extinguisher fitted (8/9 kg.):
Are electrical generators, control boxes, lighting system
effectively earthed and bonded to main engine frame:

PART 2
Certification
Type of starter motor and switches Manual or pneumatic or electrical non-sparking or lockable
(ref. Safety Regulations Section 7.18): control system
Exhaust gas temperature when discharged to atmosphere
(RS) °C - (LS) °C
(shall not exceed 300°C):
Surface temperature of engine and exhaust under full load
(RS) °C - (LS) °C
conditions (shall not exceed 250°C):
Automatic over speed shutdown valve fitted to the air Operating at RPM:
intake line: Type/Make :
Engine crank case oil capacity (Note 1):
Dipstick screwed into crank case block:
Next inspection due:
Suitable for Zone 2 area only - No access to Zone 1 Area without authority
Note 1: Desirable that engine with a crank case volume of over 0.5m 3 is provided with a relief device. Relief valves or breathers on
engines shall be fitted with flame traps or alternatively discharge into the induction system downstream of the flame trap and
upstream of the shutoff valve. Dipsticks should be screwed.

Inspector Inspector’s Stamp Authorised Signatory

Name: Name :
Signature: Signature:

Page 2 of 2

LIABILITY:
The client or his assignee agrees to indemnify and hold harmless DNV GL from and against any and all claims, demands, law suits, or action for damages ,including
legal fees to person and/or property tangible, intangible, or otherwise which may be brought against DNV GL incidental to arising out of or in connection with the work
to be done, services to be performed or material to be furnished except for those claims caused by solely and completely by the negligence of DNV GL or it’s nspectors.