Dangerous Goods Check Sheet Form – Fill Out and Use This PDF

2015

DANGEROUS GOODS CHECKLIST FOR A NON-RADIOACTIVE SHIPMENT

The recommended checklist appearing on the following pages is intended to verify shipments at origin. Never accept or refuse a shipment before all items have been checked.

Is the following information correct for each entry?

SHIPPERS DECLARATION FOR DANGEROUS GOODS (DGD)

YES NO* N/A

1.Two copies in English and in the IATA format including the air certification

statement [8.1.1, 8.1.2, 8.1.6.12] ..................................................................................................................

2.Full name and address of Shipper and Consignee [8.1.6.1, 8.1.6.2] ...........................................................

3.If the Air Waybill number is not shown, enter it. [8.1.6.3] .............................................................................

4.The number of pages shown [8.1.6.4] ..........................................................................................................

5.The non-applicable Aircraft Type deleted or not shown [8.1.6.5] .................................................................

6.If full name of Airport or City of Departure or Destination is not shown, enter it. [8.1.6.6 and 8.1.6.7] Information is optional...................................................................................................................................

7.The word “Radioactive” deleted or not shown [8.1.6.8] ................................................................................

Identification

8.UN or ID Number, preceded by prefix [8.1.6.9.1, Step 1].............................................................................

9.Proper Shipping Name and the technical name in brackets for asterisked entries [8.1.6.9.1, Step 2] ........

10.Class or Division, and for Class 1, the Compatibility Group, [8.1.6.9.1, Step 3] ..........................................

11.Subsidiary Risk, in parentheses, immediately following Class or Division [8.1.6.9.1, Step 4]......................

12.Packing Group [8.1.6.9.1, Step 5].................................................................................................................

Quantity and Type of Packing

13.Number and Type of Packages [8.1.6.9.2, Step 6].......................................................................................

14.Quantity and unit of measure (net, or gross followed by “G”, as applicable) within per package

limit [8.1.6.9.2, Step 6] ..................................................................................................................................

15.When different dangerous goods are packed in one outer packaging, the following rules are complied with:

–Compatible according to Table 9.3.A. ....................................................................................................

–UN packages containing Division 6.2 [5.0.2.11(c)].................................................................................

–“All packed in one (type of packaging)” [8.1.6.9.2, Step 6(f)] .................................................................

–Calculation of “Q” value must not exceed 1 [5.0.2.11 (g) & (h); 2.7.5.6; 8.1.6.9.2, Step 6(g)] ...............

16.Overpack

–Compatible according to Table 9.3.A. [5.0.1.5.1] ...................................................................................

–Wording “Overpack Used” [8.1.6.9.2, Step 7].........................................................................................

–If more than one overpack is used, identification marks shown and total quantity of dangerous goods [8.1.6.9.2, Step 7].........................................................................................................................

Packing Instructions

17.Packing Instruction Number [8.1.6.9.3, Step 8] ............................................................................................

18.For lithium batteries in compliance with Section IB, “IB” follows the packing instruction [8.1.6.9.3,

Step 8] ..........................................................................................................................................................

Authorizations

19.Check all verifiable special provisions. The Special Provision Number if A1, A2, A4, A5, A51, A81, A88, A99, A130, A190, A191 [8.1.6.9.4, Step 9]...................................................................................................

20.Indication that governmental authorization is attached, including a copy in English and additional approvals for other items under [8.1.6.9.4, Step 9] ......................................................................................

Additional Handling Information

21.The mandatory statement shown for self-reactive and related substances of Division 4.1

and organic peroxides of Division 5.2, or samples thereof, for PBE and for fireworks [8.1.6.11.1, 8.1.6.11.2, 8.1.6.11.3 and 8.1.6.11.5]...........................................................................................................

22.Name and Telephone Number of a responsible person for Division 6.2 Infectious Substance

shipment [8.1.6.11.4] ....................................................................................................................................

23.Name and Title (or Department) of Signatory, Place and Date indicated and Signature of

Shipper [8.1.6.13, 8.1.6.14 and 8.1.6.15] .....................................................................................................

24.Amendment or alteration signed by Shipper [8.1.2.6] .................................................................................

56th EDITION, 1 JANUARY 2015

969

YES NO* N/A

AIR WAYBILL–HANDLING INFORMATION

25.The statement: “Dangerous goods as per attached Shipper's Declaration” or “Dangerous Goods as per attached DGD” [8.2.1(a)] ..............................................................................................................................

26.“Cargo Aircraft Only” or “CAO”, if applicable [8.2.1(b)].................................................................................

27.Where non-dangerous goods are included, the number of pieces of dangerous goods shown [8.2.2] .......

PACKAGE(S) AND OVERPACKS

28.Packaging conforms with packing instruction and is free from damage or leakage [The relevant

PI and 9.1.3] .................................................................................................................................................

29.Same number and type of packagings and overpacks delivered as shown on DGD [9.1.3]........................

Markings

30.UN Specification Packaging, marked according to 6.0.4 and 6.0.5:

–Symbol and Specification Code..............................................................................................................

–X, Y or Z meets or exceeds Packing Group/Packing Instruction requirements......................................

–Gross Weight within limits (Solids, Inner Packagings or IBCs [SP A179]) .............................................

–Infectious substance package marking [6.5.3.1] ....................................................................................

31.The UN or ID number(s) [7.1.4.1(a)].............................................................................................................

32.The Proper Shipping Name(s) including technical name where required [7.1.4.1(a)]..................................

33.The full name(s) and Address(es) of Shipper and Consignee [7.1.4.1(b)] ...................................................

34.For consignments of more than one package of all classes (except ID 8000 and Class 7) the net quantity, or gross weight followed by “G”, as applicable, unless contents are identical, marked on the packages [7.1.4.1(c)] ....................................................................................................................................

35.Carbon Dioxide, Solid (Dry Ice), the net quantity marked on the packages [7.1.4.1(d)] ..............................

36.The Name and Telephone Number of a responsible person for Division 6.2 Infectious Substances shipment [7.1.4.1(e)].....................................................................................................................................

37.The Special Marking requirements shown for Packing Instruction 202 [7.1.4.1(f)] ......................................

38.Limited Quantities mark [7.1.4.2] ..................................................................................................................

39.The Environmentally Hazardous Substance Mark [7.1.5.3]..........................................................................

Labelling

40.The label(s) identifying the Primary risk as per 4.2, Column D [7.2.3.2; 7.2.3.3(b)].....................................

41.The label(s) identifying the Subsidiary risk, as per 4.2, Column D [7.2.3.2; 7.2.6.2.3].................................

42.Cargo Aircraft Only label [7.2.4.2; 7.2.6.3]....................................................................................................

43.“Orientation” labels on two opposite sides, if applicable [7.2.4.4].................................................................

44.“Cryogenic Liquid” labels, if applicable [7.2.4.3] ...........................................................................................

45.“Keep Away From Heat” label, if applicable [7.2.4.5] ...................................................................................

46."Lithium battery" label, if applicable [7.2.4.7]................................................................................................

47.All required labels are displayed correctly [7.2.6] and all irrelevant marks and labels

removed or obliterated [7.1.1; 7.2.1].............................................................................................................

For Overpacks

48.Packaging Use markings and hazard and handling labels, as required must be clearly visible or reproduced on the outside of the overpack [7.1.7.1, 7.2.7] ..........................................................................

49.The word “Overpack” marked if markings and labels are not visible [7.1.7.1]..............................................

50.If more than one overpack is used, identification marks shown and total quantity of dangerous

goods [7.1.7.2] ..............................................................................................................................................

GENERAL

51.State and Operator variations complied with [2.8]........................................................................................

52.Cargo Aircraft Only shipments, a cargo aircraft operates on all sectors ......................................................

53.For IB lithium batteries, one “lithium battery document” with the required information accompanying the consignment [8.1.6.11.7] ..............................................................................................................................

Comments:

Checked by:

Place:Signature:

Date:Time:

*IF ANY BOX IS CHECKED “NO”, DO NOT ACCEPT THE SHIPMENT AND GIVE A DUPLICATE COPY OF THIS COMPLETED FORM TO THE SHIPPER.

970	56th EDITION, 1 JANUARY 2015