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Annx C3

modl for of crticatfor typ S tporary works1

Na of Projct _________________________________

Na of Structur _________________________________Structur Rf No _________________________________

1. We certify that reasonable professional skill and care has been used in the checking of the design for

the temporary works comprising (description of temporary works)2listed in the attached schedule.

We also certify, but without undertaking any responsibility other than towards (name of organisationprocuring the temporary works) that in our opinion the erection proposals and proposed temporary

works details specied in the attached schedule for the execution of (project title) are satisfactory for

the proper discharge of his responsibilities, for the safety of the said part of the Works and for theirsafe execution in accordance with the drawings and specication and without detriment to the related

permanent works3, 4

.

Signed ________________________________

Name ________________________________

Temporary Works Checker

Engineering Qualications ________________________________ 5

Name of Organisation ________________________________

Date ________________________________

Signed ________________________________

Name ________________________________

Position held ________________________________

Name of Organisation ________________________________

procuring the temporary works

Date ________________________________

2. The permanent works Designer is satised that the temporary works have no detrimental effectson the permanent works6

Signed ________________________________

Name ________________________________Permanent Works Designer

Engineering Qualications ________________________________ 5

Name of Organisation ________________________________

Date ________________________________

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DeSIGN AND CHeCK CeRTIFICATe

(Typ S Tporary Works)

Na of Projct

Na of Structur

Structur Rf No

Dat

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Nots

1. A copy of this certicate should be forwarded to the TAA for retention with the AIP, except for Category 0, for the permanent

structure to which it relates.

2. The description to be inserted must dene unambiguously the extent of the structure to which the check is to be applied.Where necessary the extent of the Works must be shown on the drawings and the relevant Drawing numbers stated.

3 Delete and without detriment to the related permanent works if the check is carried out by permanent works Designer.

4. If there is a detrimental effect on the permanent works, an Addendum to the permanent works AIP must be submitted to the TAA

for review.

5. Engineer with appropriate qualication and experience for Categories 0 and 1, and with CEng, MICE, MIStructE or equivalent

for Categories 2 and 3.

6. This clause is not required if the check is carried out by permanent works Designer.

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DeSIGN AND CHeCK CeRTIFICATe

(Typ S Tporary Works)

Na of Projct

Na of Structur

Structur Rf No

Dat