2025年特种设备型式试验报告.pdfVIP

穷则独善其身，达则兼善天下。——《孟子》

附件G

报告编号：

特种设备型式试验报告

设备种类：场(厂)内专用机动车辆

设备类别：

设备品种：

型号规格：

制造单位：

约请单位：

(印制型式试验机构名称)

(注：本报告是按照本规则场(厂)内专用机动车辆应当进行的全部试验项目及其内容编

排的，型式试验机构应当针对不同类别、品种的场车及其安全保护装置和部件，根据本规则

规定的相应型式试验项目和内容进行编制和填写。本注不印制。)

先天下之忧而忧，后天下之乐而乐。——范仲淹

注意事项

1.本报告是依据《场（厂）内专用机动车辆安全技术监察规程》（TSG81-20XX）

进行型式试验的结论报告。

2.本报告书应当由计算机打印输出，或者用钢笔、签字笔填写，字迹要工整，

涂改无效。

3.本报告书无试验、审核、批准人员签字以及型式试验机构的核准证号、试

验专用章(或公章)和骑缝章无效。

4.本报告一式三份，一份型式试验机构存档，两份约请单位保存。

5.制造单位对型式试验结论有异议时，应当在取得本报告后15个工作日内

向型式试验机构提出。

6.本报告仅对样机(品)有效。

型式试验机构地址：

邮政编码：

联系电话：

先天下之忧而忧，后天下之乐而乐。——范仲淹

目录

场(厂)内专用机动车辆型式试验结论报告·································································第·页

一、样机主要参数·········································································································第·页

二、样机主要结构型式及整机照片·············································································第·页

三、样机技术文件审查·································································································第·页

四、样机型式检验·········································································································第·页

五、样机型式试验·········································································································第·页

六、制造单位名称变更情况································