FAILURE ANALYSIS REPORT

Owner: PT DARMA HENWA TBK Project/Site: ACP (Asam Asam Coal Project)
Reported By Abrissal Sanusi Date:
Equipment Number Model:
Serial Number Unit HM Unit:
Component Information:
Component Description: Component P/N:
Date Component Install Date Component
Fail/Remove
Mach Hrs Install Mach Hrs Removed
Component Life/Hrs Engine Serial Number
WO Number Status of Component
Dealer/Supplier PT United Tractors Component S/N -

Document Support Required:

NO DESCRIPTION Y/N COMMENTS

Component Installation/Commissioning Report
1
component fitted
2 Data Logging Unit (Download Data)
3 Photo of component fail & Filter Cut
4 Repair & Maintenance History
5 SOS report & Action taken/Feedback
Initial service report after 50 hrs or 100 hrs
6
operation
7 Performance test Report (PM Clinic, TA2 etc)
8 Last Component Change Out (CCO) report
9 PCR Report
10 Warranty Claim
11 Payload data
12 QA report/ pre start check report/P2H
PM service work order sheet before component
13
failure (2 period before)
Background:

Description/condition of the equipment found during inspection (Facts of the Damage):

Root cause of the Failure:

Corrective Action Required:

Failure Parts:

Part Number Description Component Group Qty Remarks

Responsibility Job Repair by:

OEM
DEWA-PM-FORM-33 Halaman 1 dari 3
REVISI 02
Dokumen Tidak Terkendali Jika Dicetak
 FAILURE ANALYSIS REPORT

 Dealer

Darma Henwa

Report Prepare by : Abrissal Sanusi Checked by:

Reliability Engineer Maint. Superintendent

ATTACHMENT

DEWA-PM-FORM-33 Halaman 2 dari 3

REVISI 02
Dokumen Tidak Terkendali Jika Dicetak
 FAILURE ANALYSIS REPORT

DEWA-PM-FORM-33 Halaman 3 dari 3

REVISI 02
Dokumen Tidak Terkendali Jika Dicetak