Doc No :

S-000-1654-400-F.10
Pembangunan Aviation Fuel System & DPP Rev :
Kulon Progo Project Date :

□CARRY-IN/□MONTHLY EQUIPMENT INSPECTION CHECKLIST

[GONDOLA/LIFT]

Type of Equipment : CARRY-IN CERTIFICATE

Equipment No. : Permit No. :
Capacity : Date :
Manufacturer : Approved by :
Subcontractor : Reviewed by :
Date of Deployment : Inspection shall be carried out at carry-in
Month of Inspection : and at least once a month

[Subjects] □ Gondola □ Cargo Lift □

[Result Column]  : Yes/Good, Acceptable, X: Not/Bad, Not to use, NA: Not applicable.

No. Check Item Check Points Result Remarks

1. Gondola/Lift
a Overhang Support Arms
b Wire Ropes/Shackles
c Reel Winding/Sheaves
d Electro/Mechanic Brakes
e Hand Control Device
f Stopper/Latches
g Cage/Handrail
h Bolts/Nuts/Bearing
i Control Panel
j Motor
k Cab tire Cable/Earth
l Over-Wind Warning Devices
m Emergency Stopper
n Lift: Guide Rails/Support
o Shuttering Doors
p Safe Guards for moving parts
Damage, Anchor, Counter weight
Damage, Deform., Cut
In order, Breakage, Lubricant
Operating check
Operating check
Breakage, Function
Breakage, Missing
Looseness, Missing, Lubricant
Breakage, Earth, Function
Abnormal sound, Overheat
Damage, Terminal, Connection
Breakage, Function
Breakage, Function
Breakage, Deformation
Breakage, Deformation
Breakage, Missing

2. Indication/Signs
a Operator’s Name Indication
b Weight/Person No. Limitation Indication
c Warning Signs Indication
d Carry-in Certificate Possession

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 Doc No :
S-000-1654-400-F.10
Pembangunan Aviation Fuel System & DPP Rev :
Kulon Progo Project Date :

Subcontractor/Supplier JGC INDONESIA

Approved by : Safety Manager :

Reviewed by : Reviewer :

Inspected by : Inspector :

Date : Date :

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