Doc.

No : FORM-03-OHSE-49
WEEKLY BASIC PUMP Revision
Date
: 00
: 15 Nov 2017
CHECKLIST Page : 1 of 1

Project/Site :
Date of Inspection :
Merk / Manufacture :
Contractor :
Location of inspection :

No Description Good Bad N/A Remarks

EQUIPMENT AND TOOLS

1 Appearance ( Damage, Defects, Fixing )

2 Motor ( Abnormal Sound, Overheat )

3 Safeguard ( Damaged, Missing )

4 Earth for Movable Equipment ( Missing. Resistance )

5 Frame ( Body ), Earth ( Missing, Resistance )

6 Installation / Fixing ( Stable, Securely )

7 Abrasive Disk / Blade ( Abrasion / Defects )

8 Hand Switch ( Function, Damage, Location )

CABLE / CONNECTOR

1 Cable/ Insulation ( Quality, Capacity, Damage )

2 Cable connector ( Water- Proof , Damage )

3 Cable Terminals / Clamps ( Damage, Secure, Missing )

Lying ( Not to be Damaged )- ( Overhung, Burried,
4
Protection )

Comments

Inspected by contractor (OHSE & Authorized Person ) Acknowledge by OHSE Dept

Name : Name : Name :
Position: Position: Position :
Sign : Sign : Sign :