‫الــفـــريــــق الســتــشــــارات الســـالمــــة‬

TEAM SAFETY CONSULTANTS

EXAMINATION AND TEST OF LORRY LOADER
Job No.: Certificate / Report No.:

Client Name & Address Survey Requested by:

Location: Reference Regulation:

BS 7121 – 4:2010
Date of Previous Test: Previous Test Done by: Type of Inspection:

TRUCK DETAILS
Owner Distinguishing Mark/No Registration Plate No. Manufacturer:

Chassis No: Model: Year of Manufacturer:

CRANE DETAILS
Manufacturer: Rated
Proof/Test
Radius (m) Capacity(Kg
Load(Kg)
)
Serial No: Capacity:

Model: Year of Manufacture:

TSC Test Method No. TSC Test Equipment No. Date Of Inspection Date of Issue Date of Expiry

EQUIPMENT STATUS:
Name and position of person who SATISFACTORY
Carried out the inspection and test:
NOT SATISFACTORY

_______________

Inspection Engineer

TSC-F-91C (Rev.07) (20/04/2019) Page 1 of 3

 TSC Approved by:
Labor Ministry, Dubai Municipality
Civil Defense – Dubai & Jebal Ali Free Zone Authority (Trakhees)
Member of Lifting Equipment Engineers Association (LEEA),
ISO 9001:2015 (QMS) Certified Company
Member of Scaffold & Access Industry Association (SAIA)
Institution of Occupational Safety and Health (IOSH)
Emirates International Accreditation Center ( EIAC- Dubai Municipality)
Accreditation Certificate No – 004 IB

TEAM SAFETY CONSULTANTS, TRADE LICENSE NO.500714, AL – GARHOUD, P.O.BOX: 112349, DUBAI – UAE, TEL: 042828868, FAX: 04-2865265

Continuation of Job No.: Certificate /Report No.:

ITEMS CHECKED A B C REMARKS
Documentation
Previous Test Certificate/Report
Operation Manual
Maintenance Record
Card/Operators Training Certificate
In Cab
PTO Cab Switch Operation
Handbrake Interlock (If Fitted)
Height Warning Signs
Revolving Beacon / Light
Attachments
Operation of Attachment (If Fitted)
Condition of Attachment (e.g. Brick Grab Rubbers)
Stowing of Attachment
Hydraulic System
Hydraulic Fluid
Hydraulic Cylinder Termination Condition
Hydraulic Hoses
Hydraulic Motors
Hydraulic Pumps & Valves
Hydraulic Oil Level
Stabilizers
Lock Stabilizer Beam Cam
Stabilizer Beam Secondary Locks
Swing Up stabilizer Locks
Stabilizer Hoses and Pipework
Loader Crane
Loader Operation
Control Levers Operation / Remote
Rated Capacity Indicator (RCI) Operation (If Fitted)
Emergency Stop Switches Operation
Height Warning Device Operation
Additional Safety System
Lifting Limit Switch Operation (Upper Limit Switch)
Swing Left and Right Operation
Derricking Up and Down Operation
Hoses and Pipework Condition
Hook and Safety Latch Condition
Loader Stowing Device (Transport Position)
Attachment of Loader to Vehicle
Overload Device Operation (If Fitted)
A – Satisfactory B – Not Satisfactory C – Not Applicable
OTHER REMARKS & RECOMMENDATION

TSC-F-91C (Rev.07) (20/04/2019) Page 2 of 3

TSC-F-91C (Rev.07) (20/04/2019) Page 3 of 3