Form XXXII

(Prescribed under Schedule – H (v), H (xxx) and H (xxxi) to Rule - 66)

[Report of Examination and Test of Dust Extraction of Supersession System]

1 Description of system

2 Hood-

(a) Serial number of hood

(b) Contaminant captured

(c) Capture Velocities (at points to be specified)

Design Value Actual Value

(d) Volume exhausted at hood

(e) Hood Static Pressure

3 Total Pressure drop at--

(a) Joints

(b) Other points of system (to be specified)

4 Transport velocity in duct at points along ducts (to be specified)

5 Air cleaning device--

(a) Type used

(b) Velocity at inlet

(c) Static pressure at inlet

(d) Velocity at outlet

(e) Static Pressure at outlet

6 Fan-

(a) Type used

(b) Volume handled

(c) Static Pressure

(d) Pressure drop at outlet of fan

7 Fan Motor-

(a) Type

(b) Speed and power in kilowatts

Particulars of defects, if any, disclosed during

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test of any of the above components

I certify that on (date ............................................) the above dust extraction system was

thoroughly cleaned and so far as its construction permits made available for thorough examination. I

further certify that on the said date, I thoroughly examined the above dust extraction system including

its components and fittings and that the above is a true report of my examination.

Signature .....................

Qualification .................

Address .......................

Date ..........................

If employed by a company or association, name and address of the company or association.