‫الــفـــريــــق الســتــشــــارات الســـالمــــة‬

TEAM SAFETY CONSULTANTS L.L.C

EXAMINATION AND TEST OF LPG SYSTEM

Job No: Certificate/Report No.:

Name & Address of Owner of Equipment: Name & Address of Client:

Location: Reference Regulations: Survey Requested by:

Date of Previous Test: Previous Test Done By: Type of Inspection:

DESCRIPTION
I.D. NO. QTY. REMARKS
(Make/Name, Model, Type, Dimensions, Date of Manufacture, etc)

LPG SYSTEM

Isolation Valve & Fittings :

Emergency Switch :
Pressure Regulating Valve :
Regulating Pressure :
Solenoid Valve :
Leak detector :
Warning alarm :
Initial L.E.L :
Leak Test :
Corrosion @ distraction panel :
Fire Extinguisher/Deluge system:
Fire panel-Gas panel Interface :

Date of Test Validity TSC Test Method No.: TSC Test Equipment No.: Date of Expiry
TSC / TM / TSC / EQ /

EQUIPMENT STATUS:
Name and position of person who
:carried out the inspection and test
SATISFACTORY
NOT SATISFACTORY
Inspection Engineer

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: info@tsc-uae.ae, WEBSITE: https://www.tsc-uae.ae/

TSC-F-91E (Rev.05) (22/01/2023) Page 1 of 1