LVR F 031 Brake Certificate Form

TOC Mannual - General Instructions Section 6 Train Inspection pag 103 of 350

Table 21 - Minimum brake holding time tests depending on Length of train including locomotive (metres)	Minimum brake holding time (minutes)
Up to 100	13
101 to 200	16
201 to 300	19
301 to 400	22
401 to 500	25
501 to 600	28

Brake Pipe Leakage
* PSI or KPA per Minute
Vehicle Code & Numbers of First Three Vehicles (If no Vehicles, Write N/A)
Vehicle Code & Numbers of Last Three Vehicles (Id less than Three Vehicles, Write N/A)*
Vehicles With Brakes Cut Out
List all Defects or Restrictions
List all Defects and/or Restrctions
Continuity Test Completed?*

YesNo
Driver's Name*

First NameLast Name
Maintenance Personnel Name*

First NameLast Name
Enter Your Email Address*
example@example.com
Today's Date*

DayMonthYear
Date
Train Number*
Issue of this Brake Examination Certificate confirms;

- Brake pipe leakage rate,

- Brakes have been examined,

- Brake Holding/Retention test completed,

- Undergear and connections are secure,

- Train examination is complet and red flags are removed,

- Train is fit for service,

- Maitenance personnel are clear of train consist.
Driver Signature

Clear
Maitenance Personnel Signature

Clear
Should be Empty: