C-25.1, r. 2 - Regulation respecting the form of offence reports

Schedule Disposition versions

2012-09-01

SCHEDULE VI

(s. 17, par. 6)

SUPPLEMENT TO AN OFFENCE REPORT – MODEL 3

Supplement to an offence report
(additional page)
This page may be used for: 	- The continuation of E.
	- An additional statement of facts (section F) by officers or persons different from those who presented a report on the preceding page.
	- The continuation of F.
MODEL 2
ORIGIN
Department, municipality, public body or other authority				Record No.
Name and address of person responsible					Event code

RELEVANT FACTS AND ACTIONS
Check off the appropriate box
c Continuation of E
c New section F
c Continuation of 

Weighing report
A- Vehicle class
Check off in thaw or rain period c 
Check off if dump, garbage or maintenance truck c 
Check off if modified or without GAWR c 
Check off if special travel permit (overload) c 

Axle Class
B-
A	kg
B
C
Load authorized 	kg
Load recorded	kg
Axle Class
B-
A	kg
B
C
Load authorized 	kg
Load recorded	kg

Axle Class
B-
A	kg
B
C
Load authorized 	kg
Load recorded	kg

Axle Class
B-
A	kg
B
C
Load authorized 	kg
Load recorded	kg

Axle Class
B-
A	kg
B
C
Load authorized 	kg
Load recorded	kg
TLM	Authorized	kg		Recorded		kg

TLM according to special permit	kg	Special permit No.
Configurations
Scales	Make	Model	c Series	c MTQ		Location
Check off if scale are used in compliance with Minister’s Order in force c
Operator		Surname		Given name
Type of load
*Legend
X Axles under vehicle
TLM Total loaded mass
* Mark an “X” for each axle seen
** Draw each axle seen
A The load limit specified by the manufacturer
B Load authorized for its class
C Axle load limit specified by vehicle manufacturer
		c Continued on another page

SIGNATURE
I have personally observed the facts mentioned in 		c A	c B	c C	c D	c E	c F
c Peace officer 	or	c Person responsible for enforcement of the law
Surname and given name (in block letters)
Officer’s No.	Date (Y-M-D)
Signature
SIGNATURE
I have personally observed the facts mentioned in 		c A	c B	c C	c D	c E	c F
c Peace officer 	or	c Person responsible for enforcement of the law
Surname and given name (in block letters)
Officer’s No.	Date (Y-M-D)
Signature
*CR-89A-4 (93-10)	(From prescribed by regulation to be used as documentary evidence)

O.C. 1210-97, Sch. VI.