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Date of Inspection
Place/Location
Company Name
Fill "1" in the colom with "Compliance Items" and "0" for the
EQUIPMENT :
NUMBER
Police Number / SN :
NO Item's To Be Checklist Driver/ Operator :
Name
1 AMBER WARNING - HEAVY VEHICLE ONLY / Lampu pengaman- Alat berat saja
2 TRIANGLES , RED CONES , RED FLAGS Segitiga, Kerucut , Bendera Merah
3 CABIN CONDITION ( ENGINE SMOKE,WATER LEAKS,CORROSION ) Kondisi kabin ( Asap mesin , bocor, karatan )
4 Winch Cable
5 Hour Meter / Odo Meter
Sub Total
Compliance Percentage (%)
D Mechanical / Need Assistance
1 CHECKED ENGINE OIL,TRANSMISSION OIL, HYDRAULIC OIL / Periksa minyak pelumas mesin, Transmisi, Hidrolik
2 CHECKED RADIATOR WATER, BATTERY LEVELS &TERMINALS / Periksa air radiator, Periksa air battery & Terminal
3 CHECKED DRIVE BELTS, BRAKE FLUID, FUEL / Periksa tali kipas, Minyak rem, Bahan Bakar / Diesel
4 CHECKED STEERING, SERVICE BRAKES, CLUTCH / Periksa steur, Rem kaki & Coupling
5 CHECKED TIRE, WHEEL NUTS, SPRING, A.C / Periksa ban, Baut roda, Per, S.pendingin
6 CHECKED BODY, DUMP BODY, ENGINE HOOD / Periksa bodi, Bak bodi, Tutup mesin
7 Air Gauge / Oil / Temperature Gauge (Amper udara, pelumas dan suhu)
8 Track Shoes / Bolts / Connection Link (Roda penarik, Baut/sambungan)
9 Sprocket / Idler / Rollers
Sub Total
Compliance Percentage (%)
Grand Total
Total Compliance Percentage (%)
Note:1. If Compliance Percentage in 70% -100% : Relese to Operation. 2. If Compliance Percentage Less then 7
Safety Devices Items, wil be zero tolerance, should be SWA/SSWA until fixed. 4. Eventhough the Total Complia
70%, but the Compliance Percentage Less then 70%, should SWA/SSWA Implemented.
Recommendation:
1 Equipment Continue Operation
2 Equipment Need Repairing and Continue Operation
3 Equipment Stop Operation due to Unsafe Contion to Operated.
Inspected by:
Name Badge Company Department
HEAVYTRUCKINSPECTIONCHECKLIST
No
Good N/A Remarks
Good
ocor, karatan )
smisi, Hidrolik
ttery & Terminal
l
ercentage Less then 70% : Conducted SWA/SSWA until finished repairing/replacement. 3. For the
ugh the Total Compliance more then
Equipment Number
Signed
MONTHLYHEAVYEQUIPMENT-HEAVYTRUCKINSPECTIONCHECKLIST
Date of Inspection :
Place/Location :
Company Name :
Fill "1" in the colom with "Compliance Items" and "0" for the "Non Compliance Item" cheklisted
e Item" cheklisted