No : 007-PLT-00-FRM

Tgl terbit : 19/06/2017

ANALISA BIAYA PERBAIKAN Revisi : 00
Halaman : 1 dari 2

Location : No Document :
Report Date : Unit Type :
Accident Date : Serial Number :
Accident Place : Engine Number :
Hours Meter : Code Number :
Summary Damage : Grand total cost (A+B+C+D) :

A. Evacuation Cost
N
UNIT USED PRICE/hour TOTAL HOURS TTL COST (IDR) REMARK
O
1.
2.
3.
TOTAL

B. Man Power Cost

N
MAN POWER QTY PRICE/hour TOTAL HOURS TTL COST (IDR) REMARK
O
1.
2.
TOTAL

C. Sparepart Cost
N
PART NAME PART NUMBER PRICE/pc (IDR) QTY TTL PRICE (IDR) REMARK
O
1.
2.
3.
4.
5.
6.
7.
8.
 No : 007-PLT-00-FRM
Tgl terbit : 19/06/2017
ANALISA BIAYA PERBAIKAN Revisi : 00
Halaman : 2 dari 2

9.
10.
11.
12.
TOTAL

D. Optional Cost
N
PART NAME PART NUMBER PRICE/pc (IDR) QTY TTL PRICE (IDR) REMARK
O
1.
2.
TOTAL

PREPARED BY, CHECKED BY, APPROVED BY,

MAINTENANCE PLANNER SUPERVISOR SUPERINTENDENT