Name of service / Destination
Supplier / Name / Esterline belgium BVBA
Adress / President Kennedypark 35 A
8500 KORTRIJK
Tel / Fax / E-mail
Description / Our ref.: inventary nr
Type
Serialnumber / Your ref.
Attestation by the supplier
(In execution of article 8.2 of the Royal Arrest of 12 august 1993 regarding Machinery & Equipment– see: link
artikel 9 of the Royal Arrets of 7 augustus 1995 regarding Personal Protective Equipment -see: link
en artikel 4 van het KB van 30 Augustus 2013 inzake Collective Protective Equipment-see : link)
This declaration signed by the supplier is aninseparable part of the contract and a condition before the invoice will be paid.
SAFETY DECLARATION TO BE FILLED IN BY THE SUPPLIER
The underwriter states hereby that the supplied object conforms to all applicable European laws and directives concerning safety, health and hygiene in general and all local Belgian and Flemish rules in particular, including ARAB, CODEX and AREI including all recent changes as published in the official newspaper. (In case of contradiction the European laws have priority)
The supplier confirms the object conforms with all applicable rules concerning safety, health and hygiene, not imposed by law as such, but who are necessary to meet the requirements as mentioned by the law concerning the well-being of workers(elimination of all risks inherent to the kind of the job and adaptation of the work to the human beings)
The supplier confirms the ordered object will be delivered together with a user manual in Dutch, describing the good operation, the installation, the inspection and the repair of the object, as well as all indications and warning signs are in Dutch and all pictograms are conforming to the European standards (92/58/EEG)and the Belgian normalizationstandards.
He also confirms, in case additional requirements are mentioned on the purchase order, these demands will be fulfilled as well.
In addition he confirms:
The object meets all elementary safety requirements conforming to all applicable European Directives (*)
(= not limitative list) and the latest adjustmentsof these directives :
(*) Please strike trough if not applicable or add new directives if applicable to your product :
- 2006/42/EGMachine Directive- see : link
- 2006/95/EG Low Voltage Directive- see : link
- 2004/108/EG EMC Directive –see : link
- 97/23/EG Pressure Equipment Directive - see :link
- 89/106/EGConstruction products directive – see : link
- 2009/142/EGGas appliances directive- see :link
- 93/456/EGConformity checks directive- see :link
- 94/9/EGEquipment and protective systems intended for use in potentially
Explosive atmospheres = ATEX directives – see:link
- 95/16/EGEU directive on lifts – see :link
- 89/686/EECPPE Directive –see : link
- 2001/45/ECMinimum H&S requirements for the use of equipment at work –see: link
…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
The machinery and equipment conforms with all Belgian social legislation –without exception, if applicable:
- CODEX
- ARAB
- AREI
And theEuropean harmonized standards which could be applicable to the object (= not limitative list) (**)
(**) Strike trough if not applicable or add new standards followed if any :
- EN 294, Safety of machines, Safety distances for the upper limbs.
- EN 349, Safety of machines, Minimum distances to prevent the squeezing of human bodies.
- EN 547 , Safety of machines , Dimensions of the human body
- EN 614 , Antropometric data
- EN 954 , Risik analysis
- EN 894 , Safety of machines , Ergonomic requirements for the design of the means for information and control
- EN 982 , Safety of hydraulic installations
- EN 983 , Safety of pneumatic installations
- EN 1005 , Safety of machines , Human physical load
- EN 1088 , Safety of machines , blocking devices linked with physical protections – basic design and choices
- EN ISO 7250 , Human body dimensions for technical design
- EN ISO 1050 , Safety of machines , principles of risk assessment
- EN ISO 11064 , Ergonomic design of control centres
- EN ISO 12100 , Safety of machines , basic definitions and general designrules
- EN 13849 , Risk analysis ( Performance Level )
- EN 60204 , Safety of machines – Low voltage
- EN 61100 , Electromagnetic compatibility
- EN 61310 , Safety of machines– indications , signalizations and controls
- EN 62061, SIL class of safety components
- ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
In case the object is subject to one or more EC directives, de supplier confirms the CE-label is applied as per the rules (conforming to the CE –directive and accompanied by a signed declaration of CE conformity (both one original and one copy which is the Dutch translation of this document) and all related documents: user manual, safety instructions and maintenance instructions.
In case the object is second hand machinery or equipment older than 1995 the supplier confirms in writing the machine is compliant with the minimum requirements of the Royal Arrest of 12 august 1993- Annex 1 , see: link
Additional requirements at the delivery of the purchased object :
The complete machine or installation must be presented in its final configuration and environment in which it will be used to the EHS Officer for inspection prior to first use, including :
-CE – II A certificate signed by the original manufacturer’s responsible.
-This “ Supplier certificate “ signed by the supplier’s responsible.
-User manual in Dutch and a copy in the original language of the manufacturer.
-Safety Instructions in Dutch and in the original language of the manufacturer.
-Maintenance manual in one of the following languages : Dutch ,French , German of English
-All instructions and labels on the machinery or equipment must be in Dutch or conforming to the European standard ISO 7010:2011-see: link
-All information on the display of the machinery’s control unit ( if any ) must be in Dutch
Higher mentioned requirements and this document signed are an integral part of the purchase conditions. If they are not met, this will end the purchase agreement.
All the required certificates and declarations of conformity should be handed over or send by registered letter to:
Esterline Belgium BVBA, Stamp of the supplier: ………………………………..
Att Health 1 safety officerName and function: ……………………………………
Mr. Bruno Demey
Kennedypark 35ASignature of the underwriter:…………………………
B-8500 KORTRIJK
Date :...../...... /......
Doc. nr: C.17.05 / Revision 4 / Page: 1/2