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FORM-HSE/ARUNG/GEN/015 017
Page 1 of 1
Doc. Class 3
PT. Revision 2

FORM INSPEKSI KESELAMATAN LISTRIK


Location : WEEKY MONTHLY
Date :

Condition
No Description Remark/ Recommendation
Good Fair Poor N/A
1 instalasi sesuai dengan gambar instalasi

2 Penandaan Fasa

3 Urutan Fasa (Polaritas)

4 Pemasangan Kabel

5 Panel pembagi

6 penempatan Panel

7 Penyambungan kabel

8 Peralatan Listrik

9 Stop Kontak

10 Pembumian (Grounding)

11 tahanan pembumian panel

12 sistem koneksi kabel-kabel

13 MCB

14 PVSE

15 Single line diagram

16 lampu penerangan

INSPECTED BY,

HSE DEPARTEMENT MECHANIC DEPT.

NOTE :
Priority Assesment
A : Non - Conformities and not be used until repaired
B : Have to be rapaired within 14 days
C : Have to be corrected within 1 month

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