KRS

PT. KALIRAYA SARI GRINDING MACHINE INSPECTION FORM

TYPE / CODE : DATE / TIME: :

LOCATION : PROJECT : WEEKLY MONTHLY

Cable and RPM Switch REMARK /

NO DESCRIPTION Grinding disc Motor Handle Safety guard ELCB
connector MACHINE on-off RECOMMENDATION
1

10

11

12

13

14

15

Recommendation :

Witnessed by, Inspected by,

Equipment Department HSE Department

NOTE :
Priority Assessment
A : Non - conformities and not be used until repaired R : Good
B : Have to be repaired within 14 days Q : Not Good
C : Have to be corrected within 1 month

HSE/1.01-009-F Rev. 00 - 17 Mar 2008