Proof of Engineering Certificate Review Form
Insert Address of Company
Insert ABN
Proof of Engineering Certificate Review Form
Package of work to which this Certificate refers
[Describe the package of work and state the Construction Application that it forms part of.]
I, Insert name of person certifying of Insert address as registered on the National Professional Engineers Register
(NPER) in the Area of Practice of Insert relevant Area of Practice /another international system of registration
recognised by the Dampier Port Authority [delete one] Insert name of person certifying Registration Number Insert
name of person certifying hereby certify that the documents listed below1 comply with the following:
a)
Applicable Australian Standards – see listed below2.
b)
National Construction Code – formerly Building Code of Australia (indicate where applicable)
c)
Development Conditions set by the DPA – see listed below3.
1
Documents covered by this Certificate
[List documents, ensuring that document title, document number, revision number, date of issue, and issue status
are included.]
2
Applicable Australian (or other appropriate international) Standards
[List applicable Australian Standards]
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Proof of Engineering Certificate Review Form
3
Development Conditions set by the DPA
Development Application Decision Notice No:
Rev No:
[List other Development Condition(s) as appropriate.]
Non-Standard Development Organisation Standards (indicate where applicable)
The following standards/guidelines have been assessed as adequate for their intended purpose.
[List the standards/guidelines.]
Relevant Design Assumptions (indicate where applicable)
This Certificate covers the following design assumptions, which have been reviewed and considered acceptable and
applicable to the intended purpose of this package of work:
[List any design assumptions.]
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Proof of Engineering Certificate Review Form
Non-conformances
Non-conformances [List any non-conformances observed.]
Proposed remedies [List proposed remedies for any non-conformances observed.]
Registered Engineering Practitioner’s Comments or Recommendations
[List any comments or recommendations.]
Registered Engineering Practitioner’s Certification
Name (Printed):
Witness Name (printed):
Signature:
Witness Signature:
Date:
Date:
Attachment 1:
Attachment 2:
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Copy of Registration/Licence.
List of Reports/Drawings/Documents to which this Proof of Engineering Certificate applies.
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