Report Form RD-G-KTN 5.6.

HOSE REEL & PRV INSPECTION / Revision 4

PEMERIKSAAN HOSE REEL & PRV Revision Date 5/9/2012

Page 1 of 1
Inspected by / Diperiksa oleh
Date / Tarikh:

PR No. / No. PEKERJA:

Time / Masa:

FBE 1 FBE 2 Internal 1 Internal 2 HV 1 HV 2 SPU Enamel CCP Anode Block C

Items / Perkara
B TB B TB B TB B TB B TB B TB B TB B TB B TB B TB B TB
HOSE REEL NO. 1
a) Nozzle (Breakglass/Key/Box)
b) Valve
c) Hose / Hos
d) Air pressure / Tekanan Air
e) Cleanliness / Kebersihan
HOSE REEL NO. 2
a) Nozzle (Breakglass/Key/Box)
b) Valve
c) Hose / Hos
d) Air pressure / Tekanan Air
e) Cleanliness / Kebersihan
HOSE REEL NO. 3
a) Nozzle (Breakglass/Key/Box)
b) Valve
c) Hose / Hos
d) Air pressure / Tekanan Air
e) Cleanliness / Kebersihan
HOSE REEL NO. 4
a) Nozzle (Breakglass/Key/Box)
b) Valve
c) Hose / Hos
d) Air pressure / Tekanan Air
e) Cleanliness / Kebersihan
HOSE REEL NO. 5
a) Nozzle (Breakglass/Key/Box)
b) Valve
c) Hose / Hos
d) Air pressure / Tekanan Air
e) Cleanliness / Kebersihan
HOSE REEL NO. 6
a) Nozzle (Breakglass/Key/Box)
b) Valve
c) Hose / Hos
d) Air pressure / Tekanan Air
e) Cleanliness / Kebersihan
HOSE REEL NO. 7
a) Nozzle (Breakglass/Key/Box)
b) Valve
c) Hose / Hos
d) Air pressure / Tekanan Air
e) Cleanliness / Kebersihan
PRESSURE REDUCED VALVE (PRV)
a) Pressure gauge / Meter Tekanan
b) Pressure / Tekanan
c) Valve condition / Keadaan valve
d) Cleanliness / Kebersihan
Note / Nota : B = Good / Baik TB = Poor / Tidak Baik

Corrective Action / Action taken by /

No. Plant / Area Date / Tarikh
Tindakan Pembetulan Tindakan diambil oleh
1

Reviewed by / Disemak Oleh :

Name / Nama : Signature / Tandatangan : Date / Tarikh :