1983 Ed.]
Certificate No.
證明書編號
CONSTRUCTION SITES (SAFETY) REGULATIONS
FORM 6
表格六
CAP. 59 [ 49 [Subsidiary] [reg. 29(1).] [規例第二十九條(1款)]CONSTRUCTION SITES (SAFETY) REGULATIONS
CERTIFICATE OF TEST AND THOROUGH EXAMINATION
OF
CHAINS, ROPES, AND LIFTING GEAR
Form prescribed by the Commissioner for Labour pursuant to regulation 29(1) of the Construction Sites (Safety) Regulations
建築地盤(安全)規例
鐵鏈、纜索及起重裝置之試驗及詳細檢驗結果證明書 本表格乃由勞工處長根據建築地盤(安全)規例
第二十九條第(1)款而制訂
Name and address of the contractor responsible for the chain, rope, or lifting gear tested. 對受試驗之鐵鏈、纜索或起重裝置負責之承 造商姓名及地址 Description of chain, Test load Safe work- rope, or lifting gear applied (tonnes) ing load tested and distinguish-ing marks 試驗時所使用 (tonnes) 受試驗之鐵鏈、纜索或起 之負重量(以 安全操作負重 重裝置之說明及識別標誌 公噸為單位) 額(以公噸為單位) Defects noted. If none, enter “None” 註明所發現之毛病。如無 不妥,則填「無」字。I hereby certify that on
茲證明本證書所指之起重裝置於 九
19........ the gear described in
年 月 日業經試驗及詳細檢驗
this certificate was tested and thoroughly examined by me and that the above
* 且上述各項均屬
particulars are correct.
確實無訛。
Signature 簽署 Qualification 資格 Person or firm by whom the person conducting 僱人執行此項試驗及檢驗之人士或商號 the test and examination is employed Date of certificate 簽發日期