TEAM SAFETY CONSULTANTS

CERTIFICATE OF ASSESSMENT
This is to certify that:

CERTIFIED MANAGEMENT SYSTEM

VIPIN NAIR
Nationality Passport No. Dri'in( )icence No. Co+pany Test E-.ip+ent : : : : : INDIAN !"#$%&% #*#*%$* EMIRATES C,EMICA)S ))C. FOR/)IFT Certificate No. : FE#$9 93;$< 0o: No. )ocation of Test Date
S. No
1 2 3

: AF)2C#

: 0AF1A : !" 2 !3 2 3!#$

Parameters Good Fair Poor Not Applicable

Experience as Operator Physical Health Condition Knowledge of Equipment !afety Operation of Equipment

" $ & ' )

!afety #wareness Equipment %nspection Equipment Operation (heoretical Practical

Has successfully completed one day site assessment on safe operation of FORKLIFT. Note: 4 In case of any physical 5isposition of the operator6 or any chan(es in the 7or8in( con5ition6 re9assess+ent is re-.ire5 7ithin the state5 perio5.
4 This certificate is only proof of co+petence of the person on the a:o'e 5ate. 4 Safety Orientation Pro(ra+. Name and position of person who carried out the Assessment: Authorized signatory authenticating this certificate:

MOHAMMED RIZ AN AHMED

Instructor " #utor

!!!!!!!!!!!!!!

TEAM SAFETY CONSULTANTS (TSC) APPROVALS:

Approved by L bo!r M"#"$%ry Approved by D!b " C"v"' De)e#$e

Approved by D!b " M!#"&"p '"%y Approved by +ebe' A'" )ree ,o#e

Over$e $ A$$o&" %e Me(ber o) L")%"#* E-!"p(e#% E#*"#eer$ A$$o&" %"o# (LEEA) . U/

THIS CERTIFICATE IS VALID FOR ONE (1) YEAR FROM THE DATE OF ISSUE AS PER THE CODE OF CONSTRUCTION SAFETY PRACTICE TEAM SAFETY CONSULTANTS, AL-GARHOUD, P.O.BOX 11234 , DUBA! -UAE, TEL: "4-2#2##$#, FAX: "4-2#$%2$%, E-&'(): *+,-./0&(1'*0+..0*.'0, 203+(*0: 444 *0'&+'50*6,-.+7)*'.*.,-&
#$% & AEO'(A )re*+ ,-. )/0",1"/,(/.