Equipment Inspection Checklist

Perumda Tirta Manuntung Balikpapan
Checklist for Equipment Inspection
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 1-BACKHOE LOADER (JCB) &

Note: Please write Yes or No in the given box and if some comments write in remarks column.
SN. Description Yes/No Remarks
1. Machine should be physically good & certified by #
competent authority.
2. No damage in tire (Bolts, crack, cuts & air pressure, etc.). #
3. Head & tail light and indicators are in working condition. #
4. Side mirror should be in good condition. #
5. Wind shield/glass should be in proper condition. #
6. Wiper should be in running condition.
7. Operator cabin and driver seat should be made by good #
& sound quality of material.
8. Hydraulic cylinders and hoses are in good condition #
and free from leakage.
9. Outrigger should be free from damages. #
10. Red triangle/reflective tape should be fixed in front of
vehicle.
11. Front & reverse horn. #
12. Fire extinguisher in operator cabin. #
13. First aid box in operator cabin.
14. Operator have valid and suitable license. #
FIT PARTIALLY FIT UNFIT

Inspeksi Oleh : Riview Oleh :
Nama: Name:
TTD dengan Tanggal TTD Dengan Tanggal :
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 2-EXCAVATOR &

1. Engine and rotating part should be properly covered. #
2. Track frame should be in good and working condition. #
3. Crawler belt and shoes should be in good condition. #
4. Boom and arm should be free from defects like #
corrosion, bend, etc.
5. Hydraulic cylinder and hoses should be in
good condition.
6. Bucket, cutter pins should be free from defects, e.g., #
damage, corrosion, bend, etc.
7. Teeth should be free from defects, e.g., damage, #
corrosion, bend, etc.
9. Head & tail light and indicators are in #
working condition.
12. Swing horn should be in good condition.
13. Fire extinguisher in operator cabin.
14. Operator have suitable licence/experience certificate. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 3-DUMPER &

1. Operator cabin should be fully covered and made #
by sound quality of material.
2. Carrier should be in good condition. #
8. Seatbelt should be available. #
vehicle.
10. Hydraulic cylinder and hoses should be in good condition #
and free from leakage.
11. Registration number should be written. #
15. First aid kit should be available.
16. Normal break & emergency (hand) break should be #
in functional & operational condition.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 4-EARTH COMPACTOR (ROLLER) &

1. Earth compactor should be physically in good condition. #
3. No damage in compacting roller.
4. Dangerous and moving part should be covered with fix #
guard.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 5-CONCRETE MIXER &

1. Mixer machine should be physically fit. #
2. Rotating part & IC engine should be covered with fix #
guard.
3. No damage in tire (crack, cuts & air pressure, etc.). #
4. Rotating part of gear should be covered. #
5. Proper handle lock should be available. #
6. Handle should be free from defect.
7. Mixer machine should be with proper handle to #
control the movement.
8. Spark arrestor should be installed, if machine is
operating in flammable atmosphere.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 6-TRANSIT MIXER &

1. Transit mixer should be physically in good condition. #
8. Red triangle/reflective tape should be fixed in front of vehicle.
9. Rotatory part of secondary engine should be covered with fix #
guard.
10. Rotating part of gear box should be covered by fixed guard. #
11. Inbuilt ladder should be proper with suitable guard. #
16. Normal break & emergency (hand) break should be in functional #
& operational condition.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 7-CONCRETE PUMP &

1. Concrete pump should be physically in good condition. #
4. Dangerous or moving part should be covered with fix guard. #
5. Panel/switch board should be covered properly.
6. Emergency stop button should be mushroom headed with #
red colour.
7. Concrete hopper should be in good condition.
8. Suitable mesh should be kept on hopper to avoid getting in #
touch with moving part.
9. Clamp should be proper for tight joint of pipe. #
10. Hook should have sufficient strength to carry self-load
during shifting.
11. In case of electrically operated, electrical connection should #
be taken in proper manner.
12. In case of electrically operated, machine should be #
grounded as per IS 3043:1987.
13. Concrete pump should be operated by competent person. #
14. Concrete pipe should be free from damages. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 8-BOOM PLACER &

1. Boom placer should be physically good. #
8. Boom should be free from defects. #
9. Hydraulic cylinder and hoses should be in good condition and #
free from leakage.
10. Pipe should be free from defects e.g. bend, crack, etc. #
11. Red triangle/reflective tape should be fixed in front of vehicle.
12. Rotatory part of secondary engine should be covered with fix #
guard.
15. Operator have suitable license/experience certificate. #
17. Normal break & emergency (hand) break should be in functional #
& operational condition.
18. Concrete hopper should be covered with mesh. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 9-ELECTRICAL VIBRATOR &

1. Physical condition of body should be good & sound. #
2. Power cable should be free from damages and #
connection taken through industrial plug.
3. Junction box of motor should be free from defects. #
4. On/off switch should be properly insulated. #
5. Rotating part of machine should be covered by fixed #
guard.
6. Needle should be tightly connected with motor.
7. Needle should be free from damages.
8. Machine should be grounded as per IS 3043:1987. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 10-BAR CUTTING MACHINE &

2. Junction box of motor should be full packed. #
guard.
4. Operating leaver should be insulated with #
nonconductive material.
5. Bar guard should be fixed with machine. #
8. Machine should be operated by competent person.. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 11-BAR BENDING MACHINE &

2. Electrical connection should be taken through #
industrial plug in proper manner.
3. Power cable should be free from damages. #
4. Operating switch should be free from defects, e.g., #
uninsulated & broken, etc.
5. On/off or other switches should free from defects, #
e.g., uninsulated & broken, etc.
6. Emergency stop button should be mushroom headed #
with red colour.
7. Bar support should be properly fitted with machine. #
8. Pins should be free from loose fitting. #
10. Machine should be operated by competent person. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Nama Peralatan : Pemecah

No From Ceklist 12/K3/PTMB/2022
Note: Silakan tulis Ya atau Tidak di kotak yang diberikan dan jika ada komentar tulis di kolom
komentar
1. Breaker harus dalam kondisi baik dan berfungsi. #
2. Kabel daya harus bebas dari kerusakan dan #
sambungan yang diambil melalui steker
industri.
3. Kabel fleksibel harus disediakan untuk menjaga kabel #
bebas dari kerusakan.
4. Pegangan harus disediakan untuk kontrol yang lebih #
baik.
5. Bit harus dalam kondisi baik dan bebas dari cacat #
6. Pemutus harus berinsulasi ganda jika tidak #
diarde.
7. Mesin dioperasikan oleh orang yang kompeten. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Nama Peralatan :: MESIN BOR

komentar.
1. Mesin bor harus dalam kondisi baik dan #
berfungsi.
industri.
3. Kabel fleksibel harus disediakan untuk menjaga kabel
4. Sakelar orang mati harus dalam kondisi kerja. #
5. Pegangan harus disediakan untuk kontrol yang lebih
baik.
6. Mata bor harus dalam kondisi baik dan bebas dari
cacat.
7. Selalu gunakan kunci khusus untuk melepas dan
mengganti mata bor.
8. Mesin bor harus berinsulasi ganda jika tidak diarde.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 14-HYDRA &

1. Hydra should be physically good & certified by TPI. #
5. No oil leakage in hydraulic part. #
6. Safe work load (SWL) marked. #
7. Sling drum should be in good condition. #
8. Boom condition while full extension (free from damage, #
crack & jamming, etc.).
9. Wire rope free from damage. #
10. Hoist limit switch. #
11. Safety latch in hook. #
12. Safe load indicator should be in working condition. #
15. Operator should have valid license (heavy duty). #
16. Load chart available in operator cabin.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 15-MOBILE CRANE &

1. Physical condition of body should be in sound manner. #
5. Safe work load (SWL) marked. #
6. Hoist limit switch. #
7. Wire rope free from damage. #
8. Safety latch in hook. #
9. Outrigger with spreader mat should be in good and working #
condition.
10. Sprit level should be installed. #
11. Boom condition while full extension (free from damage, crack & #
jamming, etc.).
12. No oil leakage in hydraulic part. #
13. Safe load indicator should be in working state. #
14. Front, reverse and swing horn. #
16. Operator should have valid and suitable license. #
17. Crane simulator should be in working condition. #
19. Crane should be physically good & should have valid TPI. `#

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 16-TOWER CRANE &

1. Tower crane should be physically in good condition, free #
from defects.
2. Foundation should be provided as per design. #
3. Operator cabin should be in good condition, equipped #
with wind glasses and wireless communication.
4. Safe working load should be marked. #
5. Counter weight should be properly fixed. #
6. Hydraulic cylinder, hoses should be in good condition and #
free from leakage.
7. Trolley condition should be good. #
8. Over hoist limit switch should be in working state. #
9. Limit switch should be provided for trolley motor. #
10. Sling should be free from defects. #
11. Safety latch should be in hook. #
12. Power cable should be free from damages and connection #
taken through industrial plug.
13. Tower crane should be grounded as per IS 3043:1987. #
14. Safe load indicator should be in working condition. #
15. Fire extinguisher in operator cabin.
16. Operator have suitable license/experience certificate. #
18. Tower crane should be physically good & should have #
valid TPI.
19. Anemometer should be in working condition.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: GENSET

komentar.
1. Kondisi fisik Genset harus baik. #
2. Pintu Genset harus dalam kondisi baik, sehingga #
bagian mesin yang berputar dapat menutup.
3. Panel tampilan Genset harus dalam kondisi baik.
4. Tombol berhenti darurat harus berbentuk jamur dengan #
warna merah.
5. Genset harus di-ground sesuai IS 3043:1987. #
6. Panel catu daya dilengkapi dengan ELCB/RCCB/MCB. #
7. Penahan percikan harus dipasang, jika beroperasi di
atmosfer yang mudah terbakar.
8. Tangki diesel harus bebas dari kebocoran. #
9. harus tetap pada agregat/batu kerikil.
10. Simpan CO2, pemadam api BCP/ember pasir di dekat. #
11. Sertifikat Uji kelayakan dan polusi harus diambil dari
otoritas yang berwenang.
12. Genset dioperasikan oleh orang yang berkompeten. #
13. Kit penyerap tumpahan atau baki tetesan tersedia.
14. Karet Genset terisolasi tersedia. #`

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 18-POWER/SUB DISTRIBUTION PANEL &

1. Physical condition of panel should be good & sound. #
2. Panel should be kept on suitable stand. #
3. Junction boxes should be free from defects. #
4. All connection should be taken through ELCB/RCCB/MCB. #
5. Connection socket should be covered with auto lock.
6. Switches and display should be properly covered.
7. A danger signage should be marked.
8. Panel should be grounded as per IS 3043:1987. #
9. Further connection for extension of cable should be taken #
through male-female connector.
10. In case of flammable atmosphere single length cable shall
be use.
11. Canopy should be provided to avoid water getting entered #
due to rain or any other means.
12. Rubber mat should be provided to stand during operation. #
13. Input power cable should be free from defects.
14. Power input and output cable should be passes through #
glands.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: GAS CUTTING SET

komentar..
1. Silinder harus disimpan di troli. #
2. Usahakan selalu dalam posisi tegak. #
3. Amankan dengan benar. #
4. Tutup pelindung katup. #
5. Regulator harus bebas dari cacat apapun. #
6. Pengukur tekanan harus dalam kondisi yang tepat. #
7. Provide flash back arrestor. #
8. Menyediakan klip industri.
9. Kondisi selang harus baik dengan kode warna. #
10. Sambungan harus kuat dan bebas dari cacat, misalnya #
berminyak, karat & kebocoran, dll.
11. Obor harus dalam kondisi baik. #
12. Gunakan APD yang tepat untuk Pekerjaan, mis., Sarung #
tangan kulit & kacamata pengaman, dll.
13. Simpan alat pemadam kebakaran di tempat kerja. #
14. Sediakan stan, dibuat dari bahan tahan api (jika
diperlukan).
15. Pekerjaan dilakukan oleh orang yang kompeten. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: PORTABLE GRINDER &

komentar..
1. Mesin gerinda harus dalam kondisi baik dan berfungsi. #
industri.
3. Kabel fleksibel harus disediakan untuk menjaga kabel
4. Kapasitas motor harus ditandai dalam RPM.
5. Sakelar orang mati harus dalam kondisi kerja. #
6. Pegangan harus disediakan untuk kontrol yang lebih
baik.
7. Pelindung roda harus dipasang dengan benar dengan #
mesin, sehingga celah antara pelindung dan
roda tidak boleh lebih dari 3mm.
8. Roda gerinda/potong harus bebas dari cacat dan #
kapasitas putar harus ditandai.
9. Mesin gerinda harus berinsulasi ganda jika tidak
diarde.
10. Selalu gunakan kunci khusus untuk melepas dan
mengganti roda.
12. RPM roda harus lebih dari RPM motor. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 21-WELDING MACHINE &

1. Welding machine should be in good and #
working condition.
2. Power cable should be free from damages #
and connection taken through industrial plug
and .
3. Switches should be free from defects, e.g., #
uninsulated & damages, etc.
4. Welding led & return led connection should be tightly #
by means of lugs/socket.
5. Welding led & return led should be free from #
damages, e.g., cuts, naked, too many joint,
etc.
6. Welding holder should be in good condition and free #
from metal contact.
7. Earthing holder should be in good condition and free #
from rust.
8. Welding machine should be grounded as per #
IS 3043:1987.
9. Keep fire extinguisher at working place. #
10. Provide booth, made by fire retardant material (if
required).
11. Work carried out by competent person. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 22-ELECTRICAL PUMP/MOTOR &

1. Physical condition of pump should be good. #
3. Cable entry point should be fully packed, so that #
water can’t enter.
4. Junction box of motor should be free from defects. #
5. On/off switch should be properly insulated. #
guard.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 23-WINCH MACHINE &

1. Winch should be in good and working condition and #
certified by TPI.
2. Rotating part should be covered with fixed guard. #
3. Operating liver should be free from defects. #
4. Rope drum should have sufficient space to roll-in full #
slings.
5. Wire sling should be free from damages. #
6. Sling should be knotted in proper manner. #
8. Winch should be grounded as per IS 3043:1987. #
9. Winch machine should be properly fixed with hard #
structure.
11. SWL should be written. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 24-CHAIN PULLEY BLOCK &

1. Chain pulley block should be in good and working #
condition and certified by TPI.
2. Chain should be free from defects, e.g., crack, #
corrosion, etc.
3. Hook should be in good condition, not #
stretched more than 15% of its original shape.
5. Safe working load should be marked and visible. #
6. Rotating part should be covered. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 25-LIFTING TOOLS & TACKLES &

1. Wire sling should be free from defects, e.g., #
corrosion, crack, cuts & oily, etc.
2. Use thimble for making I-shape.
3. Wire rope should be knotted with proper clamp. #
4. Web sling should be free from defects, e.g., cuts, #
abrasion, knot, hole & oily, etc.
5. I-shape should be free from damages. #
6. D-shackle should be in good condition and its face #
should not expand more than 15% of its original
shape.
7. Suitable I-bolt should be used. #
8. Lifting tools & tackles should be used having suitable #
strength & capacity.
9. Lifting tools & tackles should be handle and store in #
safe manner.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 26-AIR COMPRESSOR &

1. Physical condition of compressor tank should be good #
and certified by TPI.
2. Piston should be in good condition. #
3. Motor should be in good and working condition. #
4. Inspection date and due date should be clearly #
marked.
5. Pressure gauge should be in working state and free #
from defects.
6. Safety valve should be calibrated at regular interval. #
7. Any other valve should be free from defects and in #
working condition.
8. Rotating part should be covered with fixed guard. #
9. All joints should be properly tighten. #
10. Compressor should be grounded as per IS 3043:1987. #
11. Power cable should be free from defects and #
12. Whip arrestor is in good condition. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 27-GRIT/SAND BLASTING SET &

1. Hopper is made by sound quality of material. #
2. Pressure gauge in working condition. #
3. All joints should be properly tighten and free from #
corrosion.
4. Inlet and outlet valve should be functional. #
5. Blasting hose should have adequate strength and free #
from cuts or damages.
6. Nozzle should be in good condition with dead man #
switch.
7. Blasting hood must be provided for blaster with #
physical particle filtration.
8. Whip arrestor is in good condition. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 28-FIRE EXTINGUISHER &

1. Fire extinguisher always keep on trolley, it will be
easy for movement.
2. Keep Sand bucket. #
3. Sand bucket should be covered to avoid mixing of
foreign material.
4. Fire extinguisher should be kept at waist level height
for quick access.
5. Fire extinguisher should be free from defects and #
regularly tested.
6. Inspection date and due date should be clearly #
marked.
7. Hose and hose connection are in good condition. #
8. Check pressure gauge at regular interval for any #
pressure drop.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 29-BENCH CUTTING MACHINE &

2. On/off switch should be in proper condition. #
3. Fixed guard should be in good condition. #
4. Auto adjustable guard should be functional condition. #
5. Cutting wheel should free from defect and rotating #
capacity should be marked, standard quality of
cutting wheel used.
6. Positioning screw should be in working condition. #
7. Power cable should be free from damage and #
8. Machine should be double insulated or grounded. #
9. Always use designated key for changing wheel.
10. Machine operated by competent person.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 30-PEDESTAL GRINDER &

3. Wheel guard should be in good condition. #
4. Tool rest should be available at distance of 3 mm #
from rotating wheel.
5. Eye guard and spark deflector should be available. #
7. Wheel should free from defect and rotating capacity #
should be marked.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 31-CIRCULAR SAW &

3. Fixed guard should be in good condition. #
4. Auto adjustable guard should be functional condition. #
5. Wheel should free from defect and rotating capacity #
should be marked.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 32-BATCHING PLANT &

2. Staircase should be in good condition. #
3. Operator cabin should be free from dust #
accumulation.
4. Metal mesh should be provided on the aggregate and #
sand hopper.
5. Conveyor belt should be guarded, covered and pull #
cord should be installed.
6. Mixing chamber should be closed. #
7. Monkey ladder with cage should be available. #
8. Guardrail system should be in good condition. #
9. Lightening arrestor should be installed. #
10. All part of machine should be grounded. #
11. Power cable should be free from defect and #
connection taken through MCB and RCCB.
13. Operated by only authorized operator. #
14. Emergency switch should be in working condition. #
15. Aviation light should be in working condition.
16. Hooter is in working condition.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 33-AMBULANCE &

1. Physical condition of vehicle including brake and clutch. #
2. Condition of tire and availability of spare/stepney tire. #
4. Side mirror. #
5. Functional condition of emergency light and audible #
siren are in working condition.
6. Emergency contact number displayed. #
7. Availability and condition of stretcher. #
8. Availability of first aid kit with suitable medicine. #
9. Portable fire extinguisher. #
10. Medical oxygen cylinder with pressure gauge #
and availability of key to open the cylinder.
11. Condition of canister mask. #
12. Availability and condition of fan for ventilation. #
13. Driver has valid license for operating ambulance. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 34-SKID STEER LOADER &

1. Machine should be physically good & should have valid TPI #
certificate.
7. Operator cabin should be made by good & sound quality of #
material.
8. Hydraulic cylinders should be in good condition and free #
from leakage.
9. Foot Step should be free from slip or tip hazard.
vehicle.
13. Operator have suitable license. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 35-GRADER &

1. Machine should be physically good & should have valid #
TPI certificate.
7. Canopy above driver seat should be made by good & #
sound quality of material.
8. Hydraulic cylinders should be in good condition and free #
from leakage.
vehicle.
10. Front & revers horn. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 36-GANTRY CRANE &

1. Machine should be physically good & Should have #
valid TPI certificate.
2. SWL should be visible on either side. #
3. Walkaway should be in good condition and free from
obstruction.
4. Access ladder should be provided with cage. #
5. Proximity sensor should be in working condition. #
6. Operator cabin should be in good condition and #
clean.
7. Wire sling should be free from damage. #
8. Hook latch must be installed in hook. #
9. Guardrail system should be provided. #
10. Rotating part of motor should be covered. #
11. Wire sling drum should be under canopy. #
12. Audible horn should be in working condition. #
15. Deflection test should be carried out. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Nama Peralatan Dan Nomor : ELECTRICAL OVER HEAD TREVELER CRANE (EOT) Crane
Note: Silakan tulis Ya atau Tidak di kotak yang tersedia dan jika ada komentar tulis di kolom
komentar
SN. Description (√) /(X) Remarks

1. Mesin harus baik secara fisik & harus memiliki sertifikat #
TPI yang valid.
2. #
SWL harus terlihat di kedua sisi .
3. #
Wire sling harus bebas dari kerusakan
4. #
Kait pengait harus dipasang di pengait.
5. #
Kabel listrik harus bebas dari cacat.
6. #
Remot Kontrol harus dalam kondisi baik
7. #
Klakson yang terdengar harus dalam kondisi kerja
8. Operator memiliki sertifikat lisensi/pengalaman yang #
sesuai.
9. #
Uji defleksi / Uji Beban internal harus dilakukan .
10. #
Akses dan jalan keluar yang aman harus disediakan
PTMBPP-IR-SPI.K3/02-04

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 39-Trailer &

1. Operator cabin should be fully covered and made #
by sound quality of material.
2. Carrier should be in good condition. #
vehicle.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 40-Four Wheeler &

1. Physical condition of vehicle is good. #
8. Reflective tape should be fixed in front of vehicle.
10. Door lock are good condition. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 41-Bus &

8. Reflective tape should be fixed in front of vehicle.
10. Door lock are good condition. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 42-Diesel Tanker &

1. Physical condition of vehicle is good and free from leakage. #
8. Red triangle/Reflective tape has fixed in front of vehicle.
10. HAZCHEM code visibly written. #
11. NFPA diamond Visibly written. #
15. First aid kit should be available. #
16. Spill observant kit/drip tray available. #
17. TERM card and MSDS available. #
18. Emergency contact number available. #

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 43-Water Tanker &

1. Physical condition of vehicle is good and free from leakage. #
8. Red triangle/Reflective tape should be fixed in front of
vehicle.

Nama: Name:
Lokasi Inspeksi :
Tanggal Inspeksi :
Kepemilikan Unit :
Equipment Name & Number: 71-Bike &

2. No damage in tire (crack, cuts & air pressure, etc.). #
4. Head light and indicators are in working condition. #
6. Stand should be in proper condition. #
7. Horn is in working condition. #
8. Rider have valid and suitable license. #
9. Rider is using crash helmet during riding.
11. Break should be in functional & operational condition. #

Nama: Name:

Equipment Inspection Checklist

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Equipment Inspection Checklist

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Perumda Tirta Manuntung Balikpapan

Checklist for Equipment Inspection

Equipment Name & Number: 1-BACKHOE LOADER (JCB) &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 2-EXCAVATOR &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 3-DUMPER &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 4-EARTH COMPACTOR (ROLLER) &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 5-CONCRETE MIXER &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 6-TRANSIT MIXER &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 7-CONCRETE PUMP &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 8-BOOM PLACER &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 9-ELECTRICAL VIBRATOR &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 10-BAR CUTTING MACHINE &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 11-BAR BENDING MACHINE &

FIT PARTIALLY FIT UNFIT

Nama Peralatan : Pemecah

FIT PARTIALLY FIT UNFIT

Nama Peralatan :: MESIN BOR

9. Mesin dioperasikan oleh orang yang kompeten. #

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 14-HYDRA &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 15-MOBILE CRANE &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 16-TOWER CRANE &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: GENSET

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 18-POWER/SUB DISTRIBUTION PANEL &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: GAS CUTTING SET

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: PORTABLE GRINDER &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 21-WELDING MACHINE &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 22-ELECTRICAL PUMP/MOTOR &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 23-WINCH MACHINE &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 24-CHAIN PULLEY BLOCK &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 25-LIFTING TOOLS & TACKLES &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 26-AIR COMPRESSOR &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 27-GRIT/SAND BLASTING SET &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 28-FIRE EXTINGUISHER &

FIT PARTIALLY FIT UNFIT

Equipment Name & Number: 29-BENCH CUTTING MACHINE &