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Daily Checklist Inspection Wheel

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Doc. No. 26071-JO-HSE-INS-038
Effective Date 20 June 2020
Revision No. 001

Company : JO Reg Number :


Perusahaan Nomor Reg. JO
ID Equipment Number : Serial Number :
Nomor ID Alat Nomor Seri

Period / periode :……………/………….to / sampai ………/………….20…

OK NA DEFECT

DESCRIPTION MON TUE WED THU FRI SAT SUN REMARKS


DESKRIPSI SEN SEL RAB KAM JUM SAB MIN CATATAN
CABIN / Kabin
Meter Hours
Meter Hours (jam kerja mesin)
Cleanliness
Kebersihan
Seat condition
Kondisi tempat duduk
Seat belt must be worn
Sabuk pengaman harus
dipakai
Roofs
Atap
Pedal in condition
Kondisi pedal
Windows/wiper/washer
Jendela / wiper / pembersih
Rear view mirror
Kaca Sepion
Horn
Klakson
ENGINE / Mesin
Fuel level, and fuel leaks
Level bahan bakar dan
kebocoran bahan bakar
Oil, water and fuel leakage
Kebocoran oli, air dan bahan
bakar
Water level in radiator and
reserve tank
Ketinggian air pada tangki
radiator dan tangki cadangan
Oil hydraulic system level
Level sistem oli hidraulic
Battery water level, condition
and cover
Level air baterai, kondisi dan
penutup
V-belt tension
Ketegangan V-belt
Exhaust, spark arrestor
Knalpot , Percikan arrestor
DESCRIPTION MON TUE WED THU FRI SAT SUN REMARKS
DESKRIPSI SEN SEL RAB KAM JUM SAB MIN CATATAN
HYDRAULICS / Hidraulic
Reservoir Level
Level Tempat Penyimpanan
Hose Condition
Kondisi Selang
Cylinder Condition
Kondisi silinder
TIRES / Ban
Tread/Match
Tapak / serasi
Tire Condition
Kondisi ban
Wheel/Lugnuts
Roda / mur roda
Mud Flaps
Penyapu lumpur
BUCKET / Bucket
Cutting Edge
Tepi potongan
Lift & Tilt Cylinders
Silinder angkat / miring
LAMPS / Lampu
Head/Dimmer
Depan / dimmer
Parking
Parkir
Turn Signal, right and left
Sinyal belok, kiri dan kanan
Clearance Lamps
Lampu jarak bebas
Tail Lamps
Lampu belakang
Reverse Lamps/Alarm
Lampu berbalik / alarm
SAFETY DEVICE /
Perangkat keamanan
Fire extinguisher
APAR
First Aid Kit
Kit P3K
Rotary light
Lampu rotary
ESD system
SIstem ESD
Name of Operator
Nama operator

Signature
Tanda Tangan

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