Certificate of Proof Test of Lifting Equipment

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12/9/21, 7:47 AM

CERTIFICATE OF PROOF TEST OF LIFTING EQUIPMENT


This report complies with the requirements of the Provision and Use of Work Equipment Regulations 1998
And the Lifting
Operations and Lifting Equipment Regulations 1998
35957724252
Thorough Examination Date Certificate Number Next Examination Due Date Order No
09/12/2021 359568 08/06/2022

Name and address of Customer Examination Address Current Location Reference Standard
AL ALAMIA CO. Cairo Cairo BS EN 280:2013+A1:2015
Description and identification of the Equipment Equipment ID
Telescopic Boom Man lift

Manufacturer : SIMON Access

Model : BOXER 170E

Max Platform Height : 17.0 Meters

LF1086
Manufacture Year :1995

Machine weight : 6500 Kg

Daily checks before operation must be recorded

Check list must be recorded to revalid this certificate

Load Test Certificate Number Date of Load Test Safe Working Load Date of Last thorough examination
359568 09/12/2021 225 Kg - Max. 2 Persons + 70 Kg equipment 09/12/2021
Is this first examination after installation No Was the examination carried out within 6 months Yes
Has the Equipment been installed correctly Yes Was the examination carried out within 12 months No
In Accordance with examination scheme Yes After the occurence of exceptional circumstances No

Identification of any part found to have defect


- None

Particulars of any repair, renewal or alteration required to remedy the defect identified above
- None

Particulars of any tests carried out as part of thorough examination. And standard applied
The Man lift has been inspection and load test @ 1.25 X SWL in according with the British Standard BS EN 280:2013+A1:2015

Based on thorough examination on described above was found satisfactory or any defects have been found at time of inspection..

Is The Equipment Safe To Operate Yes Stamp


Name and Signature of the person issue this Name and Signature of the person
certificate authenticating this certificate
Mohamed Desokey Mohamed Serafy

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12/9/21, 7:47 AM

Manlift Checklist
Certificate Number : 359568

Question Check Comment


Space Bars and End Covers In Order
Controls / Operational Controls In Order
Brakes / Clutch In Order
Motor / Electric System In Order
Hydraulic System In Order
Main Gears & Reduction Gears In Order
directional controls In Order
outriggers / stabilizers N/A
Labels and Tags In Order
Tyres and Wheels In Order
Steering System In Order
Turntable Bearing In Order
Gauges in Cab In Order
Boom In Order
Lowering Speed In Order
Hoisting Speed In Order
Personnel Basket In Order
Record of Major Repairs / Alterations / Replacements N/A

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