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    Form Inspeksi Truck, Dump Truck, Trailler

    Uploaded by

    imam diani
    The document provides a checklist for inspecting trucks, dump trucks, tank trucks, and trailers. It includes checks of the vehicle's general condition, safety equipment, engine, and lifting equipment. Inspectors must check over 30 items and record their results.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Form Inspeksi Truck, Dump Truck, Trailler

    Uploaded by

    imam diani
    96 views6 pages
    The document provides a checklist for inspecting trucks, dump trucks, tank trucks, and trailers. It includes checks of the vehicle's general condition, safety equipment, engine, and lifting equipment. Inspectors must check over 30 items and record their results.

    Original Title

    Form Inspeksi Truck,Dump Truck,Trailler

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    The document provides a checklist for inspecting trucks, dump trucks, tank trucks, and trailers. It includes checks of the vehicle's general condition, safety equipment, engine, and lifting equipment. Inspectors must check over 30 items and record their results.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    96 views6 pages

    Form Inspeksi Truck, Dump Truck, Trailler

    Uploaded by

    imam diani
    The document provides a checklist for inspecting trucks, dump trucks, tank trucks, and trailers. It includes checks of the vehicle's general condition, safety equipment, engine, and lifting equipment. Inspectors must check over 30 items and record their results.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 6

    Internal

    PROJECT MANAGEMENT OFFICE

    SAFETY AND MAINTENANCE INSPECTION CHECK SHEET : (TRUCK/ DUMP TRUCK/ TANK TRUCK/ TRAILER)

    INSPECTION ITEMS

    1. GENERAL DATA

    1. 1 Tanggal Inspeksi

    1. 2 No. Register PMO

    1. 3 Merek/ Unit

    1. 4 Year Of Manufactor

    1. 5 Type/ Model

    1. 6 Rated Capacity

    1. 7 No. Polisi

    1. 8 No. KIUR

    1. 9 SIM Pengemudi

    1. 10 KIMPER Pengemudi

    1. 11 Others…
    Internal

    PROJECT MANAGEMENT OFFICE


    2. GENERAL CONDITION CHECK LIST UNIT REMARKS
    1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

    2. 1 Kondisi ruangan dalam kabin/ kebersihan **

    2. 2 Kondisi luar/ Badan kabin **

    2. 3 Sistem air condtion **

    2. 4 Fungsi panel/ Dash Board/layar monitor *

    2. 5 Kaca depan *

    2. 6 Kaca jendela kanan dan kiri **

    2. 7 Sabuk Pengaman **

    2. 8 Tempat duduk pengemudi dan penumpang *

    2. 9 Kunci pintu kabin *

    2. 10 Wiper *

    2. 11 Tangga pijakan *

    2. 12 Sistem pengemudi *

    2. 13 Pedal gas, rem dan kopling *

    2. 14 Others…

    Note :
    1. * = Daily
    2. ** = Weekly
    3. *** = Monthly
    4. Original kept by HSE Department
    5. Copy Kept by related contractor
    6. Attached SIO, SILO, Certificate, Other related document
    Internal

    PROJECT MANAGEMENT OFFICE


    3. SAFETY REQUIREMENT CHECK LIST UNIT REMARKS
    1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

    3. 1 Fire extinguisher **

    3. 2 First aid kit/ Box **

    3. 3 Rotary lamp **

    3. 4 Horn/ Klakson **

    3. 5 lampu besar/ Utama **

    3. 6 Lampu kecil/ Fog lamp **

    3. 7 Lampu rem **

    3. 8 Lampu mundur **

    3. 9 Lampu sign kanan dan kiri **

    3. 10 Alarm mundur **

    3. 11 Dongkrak **

    3. 12 Traffic cone/ Segitiga pengaman **

    3. 13 Kunci roda **

    3. 14 Ganjal ban/ Wheel chock **

    3. 15 Others…
    Note :
    1. * = Daily
    2. ** = Weekly
    3. *** = Monthly
    4. Original kept by HSE Department
    5. Copy Kept by related contractor
    6. Attached SIO, SILO, Certificate, Other related document
    Internal

    PROJECT MANAGEMENT OFFICE


    4. ENGINE CHECK LIST UNIT REMARKS
    1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

    4. 1 Kondisi ruangan mesin (Kunci berfungsi) **

    4. 2 Kondisi mesin (Oli bocor, berkarat dan lain-lain) **

    4. 3 Dudukan engine (Engine mounting) **

    4. 4 Oli mesin/ level **

    4. 5 Air radiator/ level bocor/penutup ada **

    4. 6 Sambungan-sambungan selang **

    4. 7 Pompa hydrolik **

    4. 8 Baterry (Air,kunci,pengingat,dudukan,dll) **

    4. 9 Lampu sign kanan dan kiri *

    4. 10 Alarm mundur *

    4. 11 Dongkrak *

    4. 12 Traffic cone/ Segitiga pengaman *

    4. 13 Others…
    Note :
    1. * = Daily
    2. ** = Weekly
    3. *** = Monthly
    4. Original kept by HSE Department
    5. Copy Kept by related contractor
    6. Attached SIO, SILO, Certificate, Other related document
    Internal

    PROJECT MANAGEMENT OFFICE


    5. LIFTING EQUIPMENT CHECK LIST UNIT REMARKS
    1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

    5. 1 Kunci gandeng dalam keadaan bagus *

    5. 2 Sambungan kabel-kabel ke trailer *

    5. 3 sambungan selang hydrolic *

    5. 4 Rem berfungsi dengan baik *

    5. 5 Jack trailer berfungsi dengan baik *

    5. 6 Ban cadangan tersedia ***

    5. 7 Flatbed dalam kondisi baik *

    5. 8 Semua lampu berfungsi dengan baik *

    5. 9 Tidak ada mur/ baut roda yang longgar atau lepas *

    5. 10 Semua roda dalam kondisi layak *

    5. 11 Tekanan angin sesuai pada roda *

    5. 12 Grill pelindung dalam keadaan baik *

    5. 13 Persupensi dalam keadaan baik *

    5. 14 Wheel choke/ ganjal ban ***

    5. 15 Traffic cone *

    5. 16 Rotary lamps *

    5. 17 Handrail (Tank Truck) *

    5. 18 Pump bracket (Keranjang Pompa) ***

    5. 19 Grill proteksi belakang ***

    5. 20 Others…
    Note :
    1. * = Daily
    2. ** = Weekly
    3. *** = Monthly
    4. Original kept by HSE Department
    5. Copy Kept by related contractor
    6. Attached SIO, SILO, Certificate, Other related document
    Internal

    PROJECT MANAGEMENT OFFICE

    Equipment is not allowed to be used until Major Items has been closed

    Equipment is allowed to be used while Minor Items to be closed

    Equipment is allowed to be used, no findings


    Inspected by: Checked by: Checked by: Checked by: Checked by:

    Name : Name : Name : Name : Name :


    Position : Operator Position : PM/SM Position : Inspector HSE Position : HE Coordinator Position : HSE Manager
    Date : Date : Date : Date : Date :

    Note :
    1. * = Daily
    2. ** = Weekly
    3. *** = Monthly
    4. Original kept by HSE Department
    5. Copy Kept by related contractor
    6. Attached SIO, SILO, Certificate, Other related document

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