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C-25.1, r. 2 - Regulation respecting the form of offence reports
Schedule
Disposition versions
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)
(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)
