REGULATIONS
ELECTRIC MOTORS:
Type of Plant driven by motors:
Total kilowatts of motors:
Attach list of machines driven by motors and kilowatts capacity of motors:
(nnlER ~ACEUNERY:
To
Capacity:
Kilowatt:
Other relevant d~tails:
Form 2
QUEENSLAND
Inspection of Machinery Act 1951....,1979 (Regulation 13)
NOTICE UNDER SECTION 22 (1)
Office of the Inspector
• of
• 19 I have inspected machinery, namely
owner, and I am of opinion that the
of which you are namely
*
machinery,* part of the machinery,
, is not securely fenced or otherwise sufficiently guarded and is likely to cause loss of life or bodily injury to any person employed or working with respect thereto.
Take notice that you are required within the period of from the date hereof to :!~~~f:~tl~engc:ard the said part of the machinery as follows:- t
Inspector.
ENDORSEMENT ON NOTICE
Ine within notice was given by me to the abovementioned owner
this day of , 19 , at
'by (mode of service).
Inspector.
'" Cross out whichever inapplicable.
t Insert particulars of fencing or guarding.
REGULATIONS Form 2A
QUEENSLAND
Inspection of Machinery Act 1951-1979 (Regulation 14)
Sch. n, f. 2A
NOTICE UNDER SECTION 24 (MACHINERY) Office of the Inspector
To • of
Take notice that I have inspected Machinery, namely
43
, 19 of which you are the owner, and that the machinery part arrangement thereof namely
>!<is
*appears to me to be faulty or defective in that
*"
*~ppears to me to be so dangerous as to be likely to cause loss of life or bodily injury to any person employed or working with respect thereto.
And that You ARE REQUIRED--
*to wholly desist from working or using such machinery forthwith until the replacements, repairs or alterations set out below have been effected;
*to wholly desist from working or using such machinery after the
day of ,19 • until the replacements, repairs or alterations set out below have been effected;
*to have the replacements, repairs or alterations set out below effected within days of service of this Notice;
*to produce namely or dangerous directs;
and surrender to me the part of such machinery which appears to me to be faulty, defective for the making of such examinations as the Chief Inspector
*to refrain from selling, hiring, or otherwise disposing of, or parting with the possession of, such machinery until the requirements of this notice have been complied with.
LIST OF REPLACEMENTS, REPAms OR ALTERATIONS--
Inspector.
ENDORSEMENT ON NOTICE
The within notice was given by me to the abovementioned owner this
day of , 19 • at
by (mode of service),
Inspector.
---~---~
*
Cross out whichever inapplicable.NOTE-Items struck out to be initialled by Inspector.
Form 3A
QUEENSLAND
Inspection of Machinery Act 1951-1979 (Regulation 15)
ORDER UNDER SECTION 25
To , of
*Upon consideration of a complaint made by Inspector of Machinery,-
, 19 an I am satisfied that machinery, namely of which you are the owner, is in such a condition that it cannot be used without danger of loss of life or bodily injury to any person employed or working with respect thereto.
I therefore by this order prohibit the use of the said machinery
*my satisfaction on the report of the said Inspector.
until it has been repaired or altered to *the satisfaction of the Chief Inspector on my report.
*Chief Inspector.
ENDORSEMENT ON ORDER
The within order was given by me to the abovementioned owner this
day of ,19 , at
by (mode of service).
*Chief Inspector.
- - - - - - - - -
To
*
Cross out whichever inapplicable.Form 3B
QUEENSLAND
Inspection of Machinery Act 1951-1979 (Regulation 19)
NOTICE UNDER SECTION 39 Office of the Inspector , of
, , 19 Take notice that I have inspected *a boiler namely
*an unfired pressure vessel,
, of which you are the owner, and that it appears to me that the
*boiler . fit d . t
*unfired pressure vessel IS not te WIth as
*prescribed by ,
*required by the Chief Inspector, the to you on
said requirements having been notified and that the lise or continued use of the
*boiler .
*uniired pressure vessel In its now existing state would be dangerous to life or property;
*boiler
AND THAT You ARE REQUIRED not to use the *llntired pressure vessel on and from 19 *except below a pressure of
, *until the repairs, additions, or alterations set out below have been effected.
LIST OF REPAIRS, ADDITIONS, OR ALTERATIONS-
Inspector.
REGULATIONS Sch. II, f. 4
ENDORSEMENT ON NOTICE
The within notice was given by me to the abovementioned owner this
day of ,19 ,at by (mode of service).
*Cross out whichever inapplicable.
tGive particulars.
Form 4
QUEENSLAND
Inspection of Machinery Act 1951-1979 (Section 33)
NOTICE OF INSPECfION
Inspector.
45
In accordance with the provisions of the abovementioned Act, the MACHINERY,
particulars of which are set forth below, will be inspected on , for the purpose of issuing certificate(s) of inspection in place of certificate(s) which will expire shortly.
Boiler No.* Vessel No.* I To:-
A. V. G. GOODRIDGE
Chief Inspector of Machinery, Brisbane Date:
Machine No.. Electric Group No.'"
*The number shown is the registered number allotted by the Chief Inspector of Machinery.
PLEASE NOTE-If Machinery mentioned in this Notice is not owned by the recipient of the Notice, it is necessary that he forthwith advise the Chief Inspector on this form as to the name and address of the person to whom he disposed of it
Form 5 District:
QUEENSLAND Reg. No.:
inspection of Machinery Act 1951-<1979 Plant No.:
(Section 34)
REPORT ON FIRST INSPECTION OF II<
Name and Address of Owner or Lessee:
Location:
Name and Address of Maker:
Fee to be Charged to:
Memo. of fee: Type of boiler or vessel:
Fee: Date of construction:
M.P.: Material:
Clerk of Court: Diameter:
Boiler beating surface: Lengtb:
Capacity of vessel: Tube diameter and No.:
Electric rating (kilowatts): Made to BV:
Date of inspection: Maker's No.:
Certificate recemmended to: Manufacturer's Data Report:
Repair Order issued: Date of Steam or Air Test:
W.P. recommended: Safety valve setting:
Date of inspection:
Attendant's name and qualifications:
Conditions of boiler or vessel:
Conditions of fittings and appliances:
Purpose for which used:
Remarks (Note any peculiarity of construction, position of mountings, condition of boiler or vessel generally, repairs, etc.):
Date of Report:
Signature of Inspector:
"'Boiler, air receiver, jacketted pan, digester, etc.
REGULATIONS Sch. n, f.6 47 Form 6
QUEENSLAND
Inspection of Machinery Act 1951-1979 (Section 52)
(Regulation 29) NOTICE OF ACCIDENT To Chief Inspector of Machinery,
G.P.O. Box 69, Brisbane. Q. 4001
I hereby notify you that an accident arising out of or in connection with the working or motion of machinery, namely of which I am the owner, occurred on the day of , 19 • at '"
The cause of the accident so far as it is known was
Particulars of the breakage, distortion or damage of machinery involved in the accident are as follows:
Particulars of the persons killed or suffering serious bodily injury as a result of the accident are set out on the back hereof.
Dated at this day of • 19
Signature of Owner:
*
Give precise location where the 'accident occurred.PARTICULARS OF PERSONS KILLED OR INJURED -
Married Employer's Nature of
Full Name (Surname in Place of Injuries and
BLOCK Letters) Age Single or Occupation Residence Name and Address Removed To Where
-- - - - -- - -
I
Form 7 QUEENSLAND
Inspection of Machinery Act 1951-1979 (Regulation 30)
Ref. No.:
APPLICATION FOR A CERTIFICATE OF COMPETENCY
To Chairman of the Board of Examiners 19
G.P.O. Box 69, Brisbane. Q. 4001
I hereby make application for-
(1) A Certificate of Competency as*
(2) A Copy of a Certificate of Competency as*
It is my intention to present myself for Examination at the following particulars:-
Surname (BLOCK Letters)
Christian Names (BLOCK Letters) Postal Address (BLOCK Letters) Date of birth ..
Place of birth
Name and address of present employer Number and particulars of Certificates held
(Issued under this Act)
Particulars of any o.ther Certificate ..
(Issued in other Countries or States) Attach testimonials-Give details
Personal signature of applicant
Tel. No.:
PERSONAL DESCRIPTION OF ApPLICANT
-
Height Complexion Marks or Scars (if any) Colour of Hair
and furnish
Colour of Eyes
*
Insert Engineer, Second Class Engineer, First Class Engine Driver, Second Class Engine Driver, First Class Boiler Attendant, Second Class Boiler Attendant, Third Class Boiler Attendant, Steam Locomotive Driver, Oil Locomotive Driver, First Class Crane Driver, Second Class Crane Driver, Slinger, Internal Combustion Engine Driver, Refrigeration Engine Driver, Air-conditioning Operator, "A" Grade Motor Mechanic, "B" Grade Motor Mechanic, Plant Operator.REGULATIONS Seh. II, if. 8,9 49 I do solemnly and sincerely declare that I am the person to whom Certificate of Competency was granted which-
t (a) has been lost t (b) has been destroyed
t (c) whereon the particulars have become illegible
and I make this solemn declaration by virtue of the provisions of the Oaths Acts, 1867 to 1960.
Declared before me at
Signature:
this day of , 19
A Justice of the Peace.
- - - - t Cross out whichever inapplicable.
Form 8 QUEENSLAND
Inspection of Machinery Act 1951-1979 (Regulation 30)
APPLICATION FOR PERMIT AS A LEARNER The Chief Inspector of Machinery,
I hereby make application for a permit to engage as a learner in the occupation of
'" and submit the following particulars:-
1. Surname (BLOCK letters):
2. Christian names (BLOCK letters):
3. Postal address:
4. Date of birth:
5. Place of birth:
(Town) (State) (Country)
6. Name and address of present employer:
7. Give full pa!1ticulars of where you desire to be interviewed:
8. Personal signature of applicant:
I certify that I am prepared to employ the applicant in the above capacity.
Signature of Employer:
--- ---
"'Second Class Engineer, Second Class Engine Driver, Third Class Boiler Attendant, First Class Crane Driver, Second Class Crane Driver, Internal Combustion Engine Driver, Refrigeration Engine Driver, PIant Operator.
Form 9 QUEENSLAND
Inspection of Machinery Act 1951-1979 (Regulation 51)
MEDICAL CERTIFICATE
I, (Full n.ame), a Legally Qualified Medical Practitioner, have this day examined (Insert surname then Christian names. Use BLOCK Letters), of (Postal address), and do hereby certify that he does not suffer from defective hearing or defective sight, fits, giddiness or. other infirmity likely to interfere with the efficient discharge of his duties.
Remarks (if any):
Legally Qualified Medical Practitioner.
Address:
Form 10 QUEENSLAND
Inspection 0/ Machinery Act 1951-1979 (Section 45)
(Regulations 26 and 27)
NOTICE OF SALE OF MACHINERY OR REMOVAL OF BOILER To Chief Inspector of Machinery,
G.P.D. Box 69, Brisbane. Q. 4001
I hereby notify that on the day of ... I sold/leased/let on hire/disposed of machinery, described as
Registered No.
• 19 • to (Name in full) whose ocupation is
is •
and whose place of abode
... the boiler, described as Registered No .
was removed from (Location) to (Location).
Dated at this day of • 19
Signature of Owner:
... Strike out whichever inapplicable.