Company Name…………………..
(Design Qualification DQ)
(Operational qualification OQ) (Performance Qualification PQ)
ADDRESS :
NAME OF EQUIPMENT:
MODEL: USED FOR:
SUPPLIER: CAPACITY/ SPEED:
BATCH NO:
DATE: MFD:
EQUIPMENT COMMISSIONING CERTIFICATE
This is to certify that the Equipment (details as below) has been commissioned as per the Machine /
Equipment Commissioning Procedure.
EQUIPMENT NAME :
MODEL :
MANUFACTURER :
LOCATION INSTALLED :
COMMISSIONED ON :
COMMISSIONED FROM :
(BATCH NO / MFD) : DATED :
EQUIPMENT OWNERSHIP :
EQUIPMENT CAPACITY / :
RATED SPEED
EQUIPMENT / PROCESS :
SETTINGS
(AT COMMISSIONING)
ISSUED BY (MANAGER (CQA & SHE)) :
DATE OF ISSUE :
CERTIFICATE NO
:
(To be quoted in any future communication)
Company Name…………………..
(Design Qualification DQ)
(Operational qualification OQ) (Performance Qualification PQ)
Safety check point completion reports
Safety Guard provided ( ) ( ) ( )
Double earthing provided ( ) ( ) ( )
Machine speed regulator provided ( ) ( ) ( )
Emergency push Button provided ( ) ( ) ( )
Hanging item properly Hanging ( ) ( ) ( )
Electrical Fuse/MCB provided ( ) ( ) ( )
Panel fixed with tight & proper Bolt ( ) ( ) ( )
Cabling according machine load ( ) ( ) ( )
Limit switch provided for power ( ) ( ) ( )
MCB/Fuses provided according machine ( ) ( ) ( )
Remark:
Approved by
Name Department Signature Date