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PRE-USE INSPECTION REPORT

AIR / ELECTRIC GRINDING / HAND TOOLS

Equipment ID : Model / Type :


User : Inspection Date :
Location : Next Inspection :
Date : …………………………………..

RESULT
NO CHECK POINT REMARKS ( KETERANGAN )
ACC REJECT
CLAM
1 Liner
2 Tabung Hydrolic
3 AS Hydrolic
4 Connection Hose

HYDROLIC UNIT
1 Motor
2 Tabung Oil
3 Presure Gate
4 Panel Temperature
5 Swicth On / Off
6 Rilis Valve
7 Direction Valve
8 Time Control
9 Hose

MILLING CATTER
1 Pisau / Catter
2 Motor
3 Swicth On / Off
4 Hitter

Note ( Catatan ) :

INSPECTION BY:
Diperiksa oleh 1. HSE Copi Project 2. HSE IKPT

Nama & Tanda Tangan Nama & Tanda Tangan

Date : Date :

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