CHECKLIST
TO BE COMPLETED BY CONTROL OFFICERS IN THE CARRIAGE OF DANGEROUS GOODS BY ROAD

1.

/ Place of check: / 2. Date: / 3. Time:

4.

/ Vehicle nationality, mark and registration number:

5.

/ Trailer/semi trailer nationality, mark and registration number:

6.

/ Undertaking carrying out transport / address:

7.

/ Driver / other members of vehicle crew:

8.

/ Consignor, address, place of loading:

9.

/ Consignee, address, place of unloading:

10.

/ Mode of carriage /

‮  in packages ‮  in tank ‮  in bulk

11.

/ Carriage on the exemptions related to dangerous goods packed in limited quantities under ADR 3.4 /

‮  YES

/

‮  NO

12.

/ Total quantity of dangerous goods per transport unit:

13.

/ Total quantity of dangerous goods exceed limit under ADR 1.1.3.6 /

‮  YES

/

‮ NO

SECURITY

14.

/

‮  inspected ‮  not applicable

Infringements inspected: /

Kat.*

‮  passengers on board /

II

‮  no means of identifications of each crew member /

II

‮  the vehicle is not properly supervised or parked /

II

‮  dangerous goods are not notified (This point concerns polish national regulations only) /

II

Documents on board

15.

/ Transport document / ‮  inspected‮  not applicable
Infringements inspected: /

Kat.*

‮  carriage of dangerous goods without required transport document /

I

‮  transport document withoutUN number, proper shipping name or packing group (if applicable) /

I

‮  transport document withoutadditional required information /

III

16.

/ Instruction in writing / ‮  inspected‮  not applicable
Infringements inspected: /

Kat.*

‮  carriage of dangerous goods without required instruction in writing /

II

‮  instruction in writing withoutrequiredinformation applicable to load, risk category, personal protection, general actions to be taken by driver, fire or first aid /

II

‮  instruction in writing without required additional information

/

III

17.

/ Driver’s training certificate / ‮  inspected‮  not applicable
Infringements inspected: /

Kat.*

‮  driver does not hold a valid vocational training certificate /

I

‮  driver does not hold a valid vocational training certificate in transport unit /

III

18.

/ Certificate of approval for vehicle / ‮  inspected‮  not applicable
Infringements inspected: /

Kat.*

‮  carriage in a vehicle without an appropriate certificate of approval /

I

19.

/ Other documents / ‮  inspected‮  not applicable
Infringements inspected: /

Kat.*

‮  Carriage in a vehicle without a copy of the main text of the special agreement /

III

‮  carriage in a container without a container packing certificate /

III

‮  carriage in a vehicle without the permit authorizing the transport operation /

III

‮  carriage in a vehicle without the approval certificate of the protective compartment or containment system /

III

Transport operation

20.

/ Goods authorized for transport / ‮  inspected
Infringements inspected: /

Kat.*

‮  dangerous goods are not accepted for carriage /

I

‮  carriage of dangerous goods without any indication of their presence /

I

21.

/ Leakproofness of containment systems /

‮  inspected

Infringements inspected: /

Kat.*

‮  leakage of dangerous goods from packaging, vehicle or container /

I

‮  vehicle, tank, container or packagingare damaged and present a high-level risk of death, personal injury or significant
damage to environment /

I

‮  vehicle, tank, container or packaging are damaged and present a risk of death, personal injury or significant damage to
environment /

II

22.

/ Vehicle, tank and container / ‮  inspected‮  not applicable
Infringements inspected: /

Kat.*

‮vehicle or tank no longer complies with the approval standards and presents a high-level risk of death, personal injury or significant damage to environment /

I

‮ carriage in bulk in a container which is not structually serviceable /

I

‮carriage in bulk in a container which is not accepted for carriage /

I

‮carriage of packaged goods in a container which is not structually serviceable /

II

‮vehicle or tank no longer complies with the approval standards and presents a risk of death, personal injury or significant damage to environment /

II

23.

/ Mode of carriage / ‮  inspected
Infringements inspected: /

Kat.*

‮Prohibited mode of carriage (in packages, in tank or in bulk) /

I

24.

/ Mixed loading and packing / ‮  inspected‮  not applicable
Infringements inspected: /

Kat.*

‮ the rules governing mixed loading of packages have not been complied with /

I

‮the special provision for mixed packing have not been complied with /

I

25.

/ Securing and stowage of the load / ‮  inspected‮  not applicable
Infringements inspected: /

Kat.*

‮the permissible degrees of filling of tank or packaging have not been complied with /

I

‮ the rule governing the securing of the load have not been complied with /

I

‮ the provisions limiting the quantities carried in one transport unit have not been complied with /

I

‮carriage in tank or carriage of combination packaging with an outer packaging which is not closed properly /

II

‮unprotected light is being used /

I

‮the ban on smoking is not being observed during loading and unloading operations /

I

26.

/ Packaging / ‮  inspected‮  not applicable
Infringements inspected: /

Kat.*

‮ non-approved packaging is used /

I

‮packaging does not conform to the applicable packaging instruction /

I

‮Test and inspection dates and use period of packaging have not been complied with /

II

27.

/ Marking, labelling and placarding / ‮  inspected
Infringements inspected: /

Kat.*

‮dangerous goods are carried without any placarding, marking and sign on the vehicle /

I

‮dangerous goods are carried without any marking and labelling on the packages /

I

‮dangerous goods are carried in vehicle, container or tank which are inappropriate placarded or marked /

II

‮dangerous goods are carried in packages or overpack which are inappropriate marked or labeled /

II

‮the size of placards or labels or the size of letters, figures or symbols on placards or labels does not comply with the regulation /

III

28.

/ Equipment on board / ‮  inspected‮  not applicable
Infringements inspected: /

Kat.*

‮carriage without required general purpose safety equipment /

II

‮carriage without required respiratory protective device /

II

‮carriage without requiredpersonal protection and equipment to take the additional or special action /

II

‮carriage without requiredfire-fighting equipment /

II

29.

/ Other infringements and remarks inspected:

30.

/ Authority/ officers having carried out the inspection

*Risk category in accordance with infringements inspected:

Risk category I – when failure to comply with relevant ADR provisions creates a high-level risk of death, serious personal injury or significant damage to the enviroment such failures would normalny lead to taking immediate and appropriate corrective measures such as immobilisation of the vehicle
Risk category II – when failure to comply with relevant ADR provisions creates a risk of personal injury or damage to the enviroment such failures would normally lead to taking appropriate corrective measures such as requiring rectification at the site of control if possible and appropriate, but at the current transport movement at the latest.
Risk category III – when failure to comply with relevant ADR provisions result in a low level of risk of personal injury or damage to the enviroment and where appropriate corrective measures do not need to be taken at the roadside but can be addressed at a later date at the undertaking.

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EN_ADR-Checklist