FSDRef-香港消防处.doc

FSD Ref. 消防處檔號 : Contractor Ref. 承建商檔號 : Annual Inspection Certificate 年檢證書 Ventilation of Scheduled Premises Regulation 附表所列處所通風設施規例 Address of Premises Inspected : 經視察處所的地址 : (footnote i 註腳 ) Premises Type : 處所類別 : (footnote ii 註腳 ) ( Restaurant 食肆 ( Dancing Establishment 跳舞場所 ( Theatre 劇院 ( Cinema 戲院 ( Funeral Parlour 殯儀館 ( Factory Canteen 工廠食堂 I have inspected every damper, filter and precipitator that are present in the ventilating system(s) that embody(ies) the use of ducting or trunking of the above premises on ________ (completion date of inspection). In accordance with the Regulation 6 of the Ventilation of Scheduled Premises Regulation, Cap. 132CE, Laws of Hong Kong, I certify that all dampers / filters / precipitators (delete where inappropriate), except those specified below, are in safe and efficient working order :- 本人已於 ______ (完成檢查日期) 檢查上述處所敷設有管道或幹槽的通風系統內的每個氣閘、過濾器及聚塵器裝置。現根據香港法例第132CE章《 附表所列處所通風設施規例 》第6條，本人確證除下列裝置外，所有氣閘 / 過濾器 / 聚塵器（删除不適用者）均在操作上安全和有效。 Defects observed : 存在缺點 : (footnote iii 註腳 ) Exclusion from inspection : 未包括之檢查項目 : (footnote iv 註腳 ) Name of Registered Specialist Contractor (Ventilation Works Category) : 註冊專門承建商 (通風系統工程類別）的名稱 : Chop of Registered Specialist Contractor (Ventilation Works Category) : 註冊專門承建商 (通風系統工程類別）的蓋章 : Address and Contact Telephone of Registered Specialist Contractor (Ventilation Works Category) : 註冊專門承建商 (通風系統工程類別）的註冊地址及聯絡電話 : Registration Number under Buildings Ordinance of Registered Specialist Contractor (Ventilation Works Category) : 根據《 建築物條例 》之註冊專門承建商 (通風系統工程類別）的註冊編號 : SC(V) Signature of Authorised Signatory (AS)( 授權人士簽署) Date of Certificate Issue : 證明書發出日期 : ( Full Name of AS in BLOCK letters) (授權人士姓名) (The address indicated on the licence shall be used.) (必須根據牌照上顯示的地址) (Tick as indicated on the licence) (根據牌照上顯示的類別加上 ( 號 ) (Apparatus type, location and brief account of defect have to be given. Use supplemen