CHECK LIST INSTRUKSI KERJA

(WORK INSTRUCTIONS CHECK LIST) Nomor Urut

:
SEBELUM PEMBESIAN DINDING BETON (Serial Number)
(BEFORE IRONING OF CONCRETE WALL)
Nomor Referensi Gambar
PROYEK [ Kode ] : (Drawings Reference number) :

LOKASI (LOCATION): : Revisi (Revision) :

Beri tanda (Mark) √ yang sesuai (Appropriate) Inspeksi I (Inspection I) Inspeksi II* (Inspection II)
ITEM PEMERIKSAAN Ya Tidak Tidak disyaratkan Ya Tidak
No
(WORK ITEM) (Yes) (No) (Not Required) (Yes) (No)
Shop drawing tersedia
1
(Shop drawing is available)
Cutting list & bending list tersedia
2
(Cutting list and bending list are available)
Alat tersedia dan layak pakai
3
(Tools are available and suitable ti be used)
- Bar cutter
- Bar bending
- Gunting besi manual (Manual iron scissors)
- Gegep (Tweezers)
- Alat bantu (Aids)
Fabrikasi sesuai Cutting list & bending list
4 (Fabrication is accordance with cutting and
bending list)
- Jumlah & ukuran potongan (The number and size of the pieces)
- Jumlah & ukuran tekukan (The number and size of bending)
Material kawat beton tersedia
5
(Concrete wire material is available)
Beton deking
6
(Shelter concrete)
Besi sambungan/stek/overlap min 40 D
7
(Iron connecting / cuttings / overlap min 40 D

APD yang digunakan lengkap dan sesuai dengan potensi bahaya

yang ditimbulkan
8
(PPE that is used are complete and in
accordance with potential hazard that is posed)

Mengidentifikasi potensi bahaya yang timbul serta cara

9 pengendaliannya
(Identify the hazard that arise and how to control it)

Lokasi Inspeksi (Inspection Location) : Tanggal inspeksi (Date of Inspection) Tanggal inspeksi (Date of Inspection)

Yang membuat (Created by) Yang membuat (Created by)

 Supervisor Supervisor
Alat Inspeksi (Inspection Tools) : Mengetahui (Approved by) Mengetahui (Approved by)

Quality Control Quality Control

Catatan (Note) : Rekomendasi (Recommendation) Rekomendasi (Recommendation)

Perhatian (Attention): Penanggung jawab

1 Utamakan Keselamatan Kerja (Safety First) (Responsible person)
2 Pakailah safety helmet (Used Safety Helmet)
3 Pakailah safety shoes (Used Safety Shoes)
4 Pakailah safety belt (Used Safety Belt)
5 Jagalah kebersihan lingkungan (Keep it Clean) Production Manager

*) Kolom Inspeksi II dan III digunakan apabila ada pekerjaan yang tidak memenuhi syarat ( ada Ketidaksesuaian Produk)
(Inspection columns II and III are used when there are work that do not qualify (there Incompatibility Products))
 02/MAU-MR/R0

Inspeksi II* (Inspection II) Inspeksi III* (Inspection III)

Tidak disyaratkan Ya Tidak Tidak disyaratkan
(Not Required) (Yes) (No) (Not Required)

nggal inspeksi (Date of Inspection) Tanggal inspeksi (Date of Inspection)

ang membuat (Created by) Yang membuat (Created by)

 Supervisor Supervisor
engetahui (Approved by) Mengetahui (Approved by)

Quality Control Quality Control

ekomendasi (Recommendation) Rekomendasi (Recommendation)

b
(Responsible person)

Production Manager

esuaian Produk)
`
 02/MAU-MR
CHECK LIST INSTRUKSI KERJA
(WORK INSTRUCTIONS CHECK LIST) Nomor Urut :
SEBELUM BEKISTING DINDING BETON (Serial Number)
(BEFORE FORMWORK OF CONCRETE WALL)
Nomor Referensi Gambar
PROYEK [ Kode ] : (Drawings Reference number) :

LOKASI (LOCATION): : Revisi (Revision) :

Beri tanda (Mark) √ yang sesuai (Appropriate) Inspeksi I (Inspection I) Inspeksi II* (Inspection II) Inspeksi III* (Inspection II
ITEM PEMERIKSAAN Ya Tidak Tidak disyaratkan Ya Tidak Tidak disyaratkan Ya Tidak
No
(WORK ITEM) (Yes) (No) (Not Required) (Yes) (No) (Not Required) (Yes) (No)
Shop drawing tersedia
1
(Shop drawing is available)
Pembesian dinding benar
2
(Wall ironing is correct)
Sepatu dinding & beton deking terpasang
3 (Shoes wall and shelter concrete are
installed)
Material bekisting layak dipakai
4
(Formwork material are utilizable)
Pabrikasi sesuai shop drawing
5
(Fabrication is accordance with shop drawing)
Kebersihan bekisting
6
(The sanitation of formwork)
Pelapisan bekisting dengan mold oil
7
(Coating the formwork with mold oil)

Pipe support & sabuk dinding beton tersedia dan layak pakai
8 (Pipe support and concrete
wall belt are available and suitable to be used)

Alat bantu tersedia

9
(Tools are available)

APD yang digunakan lengkap dan sesuai dengan potensi

bahaya yang ditimbulkan
10
(PPE that is used are complete and
in accordance with potential hazard that is posed)
Mengidentifikasi potensi bahaya yang timbul serta cara
pengendaliannya
11
(Identify the hazard that arise and how to control
it)

Lokasi Inspeksi (Inspection Location) : Tanggal inspeksi (Date of Inspection) Tanggal inspeksi (Date of Inspection) Tanggal inspeksi (Date of Inspection

Yang membuat (Created by) Yang membuat (Created by) Yang membuat (Created by)

Supervisor Supervisor Supervisor

Alat Inspeksi (Inspection Tools) : Mengetahui (Approved by) Mengetahui (Approved by) Mengetahui (Approved by)

Quality Control Quality Control Quality Control

Catatan (Note) : Rekomendasi (Recommendation) Rekomendasi (Recommendation) Rekomendasi (Recommendat

Perhatian (Attention): Penanggung jawab

1 Utamakan Keselamatan Kerja (Safety First) (Responsible person)
2 Pakailah safety helmet (Used Safety Helmet)
3 Pakailah safety shoes (Used Safety Shoes)
4 Pakailah safety belt (Used Safety Belt)
5 Jagalah kebersihan lingkungan (Keep it Clean) Production Manager
*) Kolom Inspeksi II dan III digunakan apabila ada pekerjaan yang tidak memenuhi syarat ( ada Ketidaksesuaian Produk)
 02/MAU-MR/R0

Inspeksi III* (Inspection III)

Tidak disyaratkan
(Not Required)

Tanggal inspeksi (Date of Inspection)

Yang membuat (Created by)

Supervisor
Mengetahui (Approved by)

Quality Control
Rekomendasi (Recommendation)
 02/MAU-M
CHECK LIST INSTRUKSI KERJA
(WORK INSTRUCTIONS CHECK LIST) Nomor Urut :
SEBELUM PENGECORAN DINDING BETON (Serial Number)
(BEFORE CONCRETE WALL CASTING)
Nomor Referensi Gambar
PROYEK [ Kode ] : (Drawings Reference number) :

LOKASI (LOCATION): : Revisi (Revision) :

Beri tanda (Mark) √ yang sesuai (Appropriate) Inspeksi I (Inspection I) Inspeksi II* (Inspection II) Inspeksi III* (Inspection
ITEM PEMERIKSAAN Ya Tidak Tidak disyaratkan Ya Tidak Tidak disyaratkan Ya Tidak
No
(WORK ITEM) (Yes) (No) (Not Required) (Yes) (No) (Not Required) (Yes) (No)
Shop drawing tersedia
1
(Shop drawing is available)
Spesifikasi mutu beton
2
( Mix Design)

Spesifikasi nilai slump test beton sesuai Mix Design

3 (Spesifikasi of slump test value of the
concrete is accordance with mix design)
Benda Uji Kubus beton sesuai BPP
4 (Test material of concrete cube is accordance with
BPP)
Peralatan cor tersedia dan layak pakai :
5 (Cast equipments are available and
suitable to be used, such as )
- Kompressor (cleaning bucket)
- Vibrator
- Bucket
- Tremie (kalau diperlukan) (If needed)
- Concrete pump (jika diperlukan) (If needed)
- Alat bantu (Aids)
Marking elevasi top cor rencana
6
(Marking the top cast elevation plan)
Bidang pengecoran dibersihkan
7
(Casting field was cleared)
Material curing compound/karung cukup tersedia
8
(Material of curing compound / sack is available)

APD yang digunakan lengkap dan sesuai dengan potensi bahaya

yang ditimbulkan
9
(PPE that is used are complete and in
accordance with potential hazard that is posed)

Mengidentifikasi potensi bahaya yang timbul serta cara

10 pengendaliannya
(Identify the hazard that arise and how to control it)

Lokasi Inspeksi (Inspection Location) : Tanggal inspeksi (Date of Inspection) Tanggal inspeksi (Date of Inspection) Tanggal inspeksi (Date of Inspec

Yang membuat (Created by) Yang membuat (Created by) Yang membuat (Created b

Supervisor Supervisor Supervisor

Alat Inspeksi (Inspection Tools) : Mengetahui (Approved by) Mengetahui (Approved by) Mengetahui (Approved by)

Quality Control Quality Control Quality Control

Catatan (Note) : Rekomendasi (Recommendation) Rekomendasi (Recommendation) Rekomendasi (Recommend

Perhatian (Attention): Penanggung jawab

1 Utamakan Keselamatan Kerja (Safety First) (Responsible person)
 2 Pakailah safety helmet (Used Safety Helmet)
3 Pakailah safety shoes (Used Safety Shoes)
4 Pakailah safety belt (Used Safety Belt)
5 Jagalah kebersihan lingkungan (Keep it Clean) Production Manager

*) Kolom Inspeksi II dan III digunakan apabila ada pekerjaan yang tidak memenuhi syarat ( ada Ketidaksesuaian Produk)
 02/MAU-MR/R0

Inspeksi III* (Inspection III)

Tidak disyaratkan
(Not Required)

Tanggal inspeksi (Date of Inspection)

Yang membuat (Created by)

Supervisor
Mengetahui (Approved by)

Quality Control
Rekomendasi (Recommendation)