Department of Labour and Employment FORM - 16 B (Prescribed under rule 105) Test report _________________________dust extraction system 1. Description of system 2. Hood (a) Serial No of hood (b) Contaminant captured (c) Capture velocities (At points to be specified (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 dust 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 horse power 8. Particulars of defects, if any disclosed during that in any of the above components I certify that on this __________________ day of ______________ the above dust extraction system, was thoroughly cleaned and (so far as its construction permits) made accessible 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 true report of my examination. Signature: Qualification: Address: Date:
