Los remitentes de la declaración de mercancías peligrosas (generador diesel)

Qantas Form 91D00675 (01/15) Page 1 of 2

1. Complete this Check Sheet in at least two copies.

2. Check YES, NO or N/A (Not Applicable) to each question.

3. Reject the shipment if the answer to any question is NO.

4. Do not reject the shipment until all questions are answered.

5. When the shipment is accepted, attach the original copy of

this check list to the waybill and retain a copy on file.

WAYBILL NO.

ORIGIN

DESTINATION

YES NO N/A

SHIPPERS DECLARATION FOR DANGEROUS GOODS (DGD)

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]. This

information is optional  

7. The word "Radioactive" deleted or not shown [8.1.6.8]  

IDENTIFICATION

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

9. Proper Shipping Name and the technical name in brackets for entries with a star [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 brackets, 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, have the following rules been complied

with:

a) Compatible according to Table 9.3.A   

b) UN packages containing Division 6.2 [5.0.2.11(c)]   

c) "All packed in one (type of packaging)” eg. fibreboard box [8.1.6.9.2, Step 6 (f)]   

d) 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. If Overpack has been used:

a) Are the dangerous goods compatible according to table 9.3.A. [5.0.1.5.1]   

b) The words “Overpack used” [8.1.6.9.2, Step 7]   

c) 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 ion batteries in compliance with Section 1B, “1B” follows the packing instruction [8.1.6.9.3, Step 8]   

AUTHORISATIONS

19. Check all variable special provisions. The special provision number(s) indicated if the Special Provision is A1,

A2, A4, A5, A51, A81, A88, A99, A130, A190 or A191 [8.1.6.9.4, Step 9]   

20. Indication that governmental authorisation 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(s) or alteration(s) signed by Shipper [8.1.2.6]   

AIR WAYBILL

25. The statement: "Dangerous

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