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PT KARYA MAS ENERGI -

PT GERINDO DWIDAYA ENERGI SOLUSI

Dokument No : Rev : Contrac No : Page Of


KKG-PPJL-JRK-HSSE-PS-006

SHACKLE INSPECTION CHECK LIST

Period of Month :

No. Diameter (mm) SWL Condition Date User / Area Remarks


Type / Name of Shackle
Body Pin (Ton) Pin Condition Body Condition Nut / Screw Pin Inspection

1. Dept Head/User 2. Supt / Supv Head 3.HES by

Name & Signature (Nama & Tanda Tangan ) Name & Signature (Nama & Tanda Tangan ) Name & Signature (Nama & Tanda Tangan)

Date : Date : Date :

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