Certificate that vehicle is safe before testing form

Certificate that vehicle is safe before testing form
RSA/ADR 4
CERTIFICATION THAT VEHICLE IS SAFE BEFORE TESTING
To be handed in when a goods vehicle used for the carriage of dangerous goods arrives at
the Vehicle Test Station for testing.
Before completing this certificate, please read all the notes overleaf
Identification of the vehicle and load
Vehicle registration No. or Trailer Identification Mark
UN Number
Placards
UN Number and classification (see overleaf of last or
Current substance carried on the Vehicle/Trailer
Now complete either DECLARATION A or DECLARATION B
DECLARATION A
I declare that the information given above (information on Vehicle and Load is correct.
I certify that the vehicle referred to above has been purged and rendered safe, for examination by the
Vehicle Examiner
Signed ______________________ Name (Print) ________________________
Company ____________________________________
Date _____________
Position in Company ___________________________
Tel No. ___________
DECLARATION B
I declare that the information given above (information on Vehicle and Load is correct.
I certify that I have read the notes overleaf and have taken all reasonable precautions with respect to the
vehicle referred to above, to render it safe for examination by the Vehicle Examiner
Signed ______________________ Name (Print) ________________________
Company ____________________________________
Date _____________
Position in Company ___________________________
Tel No. ___________
CERTIFICATION THAT VEHICLE IS SAFE BEFORE TESTING
I. Before sending your vehicle for examination at a Vehicle Test Station, please read the following notes
and carry out the necessary preparatory work to make the vehicle safe for examination. The nature of the
preparatory work will depend on the class of substance carried by the vehicle. In this connection, it is
important to note that Vehicle Testing staff will have to be underneath the vehicle at certain stages during
the goods vehicle test/examination and the preparation of the vehicle and any necessary sealing or
cleaning should take this into account.
2. If a load is required it should be of a non-hazardous nature.
3. If, in your opinion, the substance to be carried during the test has some unusual characteristics which
requires special precautions to be taken you should inform the Test Station at which your test has been
booked.
4. In all cases, the UN number, and classification of the substance carried should be stated overleaf. The
vehicle should also be accompanied by a person with a relevant training qualification (ADR Training
Certificate) applicable to the goods normally carried.
5. Make sure that the certificate on the reverse of this Form is signed by a responsible officia1 when the
preparations have been completed. This is necessary in all cases, even if the vehicle has not carried any
hazardous goods immediately prior to the test and will not do so at the test. The signed certificate must be
presented on arrival at the Test Station. Without these documents, the test will not be conducted.
6. Authorised Testers/Exaniiners will not accept under any circumstances vehicles submitted for test which
are loaded or partially loaded with dangerous goods in receptacles ( e.g. corrosives in carboys, drums,
bags) or with loose loads..
7. Information on the UN. numbers and classification of substances and packaging and labelling of
dangerous goods is contained in Volume I and Volume II of the European Agreement concerning the
International Carriage of Dangerous Goods by Road.(ADR)
HAZARD CLASSES
Class 1 - Explosives
creating large and sudden forces
Class 2 - Gases
and toxic.
Class 3 - Flammabie liquids
Class 4.1-Flammable solids
Class 4.2 - Spontaneously Combustible
Class 4.3 - Dangerous when wet
Class 5.1 - Oxidising Agents
Class 5.2 - Organic Peroxides
Class 6.1 -Toxics
Class 6.2 - Infectious Substances
Class 7 - Radioactives
Class 8 - Corrosives
Class 9 - Miscellaneous
Can change their state instantaneously into gas, thereby
Dangerous because of the pressure, but also can be flammable
Vaporise readily, and can then explode or burn with air.
Ignite and burn easily when heated.
Ignite and burn immediately in contact with air
Produce flammable gas in contact with water
Break down easily to provide oxygen to support burning
Unstable compounds, can cause fires or explosions
Can be swallowed, breathed in, or absorbed through skin
Can transmit disease if absorbed through skin.
Emit radiation capable of damaging the human body.
Attack many materials, very damaging to human tissue.
Other hazardous materials, e.g. asbestos, PCB's,
environmentally hazardous substances etc.
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