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.[8.1.6.6and8.1.6.7]
Information ## 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,Step1].............................................................................##
9.Proper Shipping Name and the technical name in brackets for asterisked entries[8.1.6.9.1,Step2]........##
10.Class or Division,and for Class1,the Compatibility Group,[8.1.6.9.1,Step3]..........................................##
11.Subsidiary Risk,in parentheses,immediately following Class or Division[8.1.6.9.1,Step4]......................###
12.Packing Group[8.1.6.9.1,Step5].................................................................................................................### Quantity and Type of Packing
13.Number and Type of Packages[8.1.6.9.2,Step6].......................................................................................##
14.Quantity and unit of measure(net,or gross followed by“G”,as applicable)within per package
limit[8.1.6.9.2,Step6]..................................................................................................................................##
15.When different dangerous goods are packed in one outer packaging,the following rules are complied
with:
–Compatible according to Table9.###–UN packages containing Division6.2[5.0.2.11(c)].................................................................................###–“All packed in one(type of packaging)”[8.1.6.9.2,Step6(f)].................................................................###–Calculation of“Q”value must not exceed1[5.0.2.11(g)&(h);2.7.5.6;8.1.6.9.2,Step6(g)]...............### 16.Overpack
–Compatible according to Table9.3.A.[5.0.1.5.1]...................................................................................###–Wording“Overpack Used”[8.1.6.9.2,Step7].........................................................................................###–If more than one overpack is used,identification marks shown and total quantity of dangerous
goods[8.1.6.9.2,Step7].........................................................................................................................### Packing Instructions
17.Packing Instruction Number[8.1.6.9.3,Step8]............................................................................................##
18.For lithium batteries in compliance with Section IB,“IB”follows the packing instruction[8.1.6.9.3,
Step8]..........................................................................................................................................................### 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,Step9]...................................................................................................### 20.Indication that governmental authorization is attached,including a copy in English and additional
approvals for other items under[8.1.6.9.4,Step9]......................................................................................### Additional Handling Information
21.The mandatory statement shown for self-reactive and related substances of Division4.1
and organic peroxides of Division5.2,or samples thereof,for PBE and for fireworks[8.1.6.11.1,
8.1.6.11.2,8.1.6.11.3and8.1.6.11.5]...........................................................................................................### 22.Name and Telephone Number of a responsible person for Division6.2Infectious Substance
shipment[8.1.6.11.4]....................................................................................................................................### 23.Name and Title(or Department)of Signatory,Place and Date indicated and Signature of
reactive substanceShipper[8.1.6.13,8.1.6.14and8.1.6.15].....................................................................................................## 24.Amendment or alteration signed by Shipper[8.1.2.6].................................................................................###
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 and9.1.3].................................................................................................................................................## 29.Same number and type of packagings and overpacks delivered as shown on DGD[9.1.3]........................## Markings
30.UN Specification Packaging,marked according to6.0.4and6.0.5:
–Symbol and ###–X,Y or Z meets or exceeds Packing Group/Packing ###–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 ID8000and Class7)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 Division6.2Infectious Substances
shipment[7.1.4.1(e)].....................................................................................................................................###
37.The Special Marking requirements shown for Packing Instruction202[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 per4.2,Column D[7.2.3.2;7.2.3.3(b)].....................................###
41.The label(s)identifying the Subsidiary risk,as per4.2,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 ###
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.

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