‫م‬.‫م‬.

‫الــفـــريــــق الســتــشــــارات الســـالمــــة ذ‬

TEAM SAFETY CONSULTANTS L.L.C
IB-004

CERTIFICATE OF EXAMINATION AND TEST OF SAFETY HARNESS

Job No: Certificate No:SH/C1

Client Name and Address: Type Of Inspection INITIAL
Ref. Standard/ Regulation BS EN 361 : 2002
Location of equipment: TSC Test Method No TSC/ITP/27
TSC Test Equipment No 05,07
Roll Name of Year
Model No Serial No
No. Manufacturer Manufactured

5
Date of Previous Test: Date of Inspection: Date of Issue: Date of Expiry:

*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

Inspection Engineer

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.

,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-17T (Rev.08) (28/01/2023) Page 1 of 2

 Continuation of Job No.: Certificate No.:
FINDINGS SECTION
Findings Target Date:

Supplementary:
a. Periodic maintenance required as per the manufacturer instruction.
b. The kit shall be checked by a qualified person before each use.
c. In case of shock loading the kit shall be discarded.

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-17T (Rev.08) (28/01/2023) Page 2 of 2