FM-SEA-OHS-003, Version 4 Forklift Gheck List Supervisor: HALILINTAR svi J “Wook of inspection r/c Depot: CIBITUNG Form Reforonce: OSH.6F-V+ (EMA Uso oni) ‘on [Tue | Weg] They Say | 00] operaorainnanl | YL AL A PLE Forlit Hour Mater Reading ‘Safety Chock (6 = Good 5S = Satisfactory; P» Poot fort E Cte le é Natmepat (Capaciy Geary mace) / papan rama [Contre (Cleauy marked uly operations) Findkator £[Cle [6 Te igh (Headignls, Tai Ups, Warning & Revetsng) Lambo Clee i¢l6 16 so EleTele sere cz CTCTE Ts | £ cUG a “Ac7 [Overhead protection in pace / peindung Kepala be] & 6 78 Wheel Nat Tight none missing) Mr roa ePlPlTel|ele fe 79 Tyresttot worn, ctr damaged) Ban 6 (eTele ero ‘Ac10 |Brakos(Poot & Hand Brakes operational) Cyelrelefvele [act [Steering(Smooth- No Slack or pay) Sistem Komedl &IETC S16 le 'a-12 |Sealng(Fimiy attached, nat dasraued or worn) / Tempat Duduk gE feleTere [a-13 seat Bt and interocng system (Operation /Sabuk Pengarian STRTCTEI[G LE [A-14 [Lit Syeter(Operatona) /Setom Angkat LTC lele ‘A-16 Tat System(Operelionad / Sistern Ming Ble yepTerels [46 [Masi(Chains & cable operaiional)/ Tieng ( ranlal dan kabel) CIGIEIEIE [Act | Tranemission(Nol sipping) / Tren ( teak tergelinoi Leyes, eye 16 Baery(Connened and charges) Beea (rhb don aay) SIZTELSITELS "ho19 |Radiator(Ciear of debris/undamaged) / Radiator (beraih) Ble; ejelelas 7-20 |e ote Conietes vest aking) Tatung Gos Cle eT ere Te) [nes a i 3-1 [Coding water evel A penangin GTElE1S Lb 13-2 [Brake td level Minyak rem C/G STE & 3 [roe of arpa ELSCTATETO Te 4 [Engine al evel / OF Mes Ble le ele le 35 [Frenamssion of evel /Mnyek anon STBLE{LIEIES oo EY ee mARIGR aT RR i i . . 4 A arenes one Nig : el: HALIUNTAR oftFM-SEA-OHS-003, Version 4, Forklift Check List Fortis YY. on Supervisor: HALILINTAR Wook of mspection: 2 O} Depot: CIBITUNG ‘porators Initials Forlit Hour Meter Roading| sxe ‘Mon | Tue [Wed] Thre Safety Chock (G = Good; $= Satisfactory; P= Poor) ae [Forkiut’ INamepiste (Capacity oary marked) /papan nama x Certols (Glerly maked-uly operational) inhaler Lions eaaights, Tall Lah, Waring & Reversing) Lampo Fan(©perafonad /Kekson ‘A [Reversing Warning Beeper Operational) / Tenda Mundur ‘<6 [Tynes Not Worn, Cul or Damaged) / Garp verhead protection place / petndung kopela 7a | Whee Nula(Tight-none missing) Mur oda 7 [Tyvea(Not worn, ci or damaged) Ban 5-40 [Brakes(Foot & Hand Brakes operabond ERKERKE Feit [Steerng(Smocth- No Slack or pay) Sistem Kernadi Kick NE RCRIK RR ‘6-12 [Gealng(Fimy allaohed, not damaged or worn) / Tempal Dudu ‘a-13 [Seat Bell ad infeloaking system (Operaianah / Sabuk Pengaman ‘Ac14 [Lt System(Operaiona/ Sistem Angkat ‘Ac15 Tit Syetem(Operatonal)/Saiom Ning "Ac [Masi(Chalns & coble operation / Tang (rant dan kabe) [ACt7| Transmission(Netstpping) / Trans ¢Waak tergedich) Keke [A-18 [Batlory(Connected and charged) / Bateral (terhubwng dan sl daya) ‘A-19 |Radisier(Glowr of dabratundameged / Raclato (bert) Ci KR ES ‘0 | Bete Connect cacti, nat alg) Tabuna Gas a arid eK KRICRE RK ARER CER IC K AUckeek ctl eck 1B [Cootng water level / Air pendingin 8:2 [Brake thd evel! Minyak rem 3:3 [fiyeraute olTevel/ Minyak nari CRE eKICERIEP KER ERR EEE ck X Chic 8-4 [Engine alevel/ 00 Mesin 15 | Tronamiseion alllovel/ Minyak (renemisi spepegeeeer a Aclonts Venn NCTM [Nee CREEK THAUILINTAR.i Forklift Check List Fort YWOTA Supervisor: HALILINTAR Week ofinspection: 7 C, 2 Depot GIBITUNG Form Rafronco: O8N-GF.1 (EW Use ony) FM-SEA-OHS-003, Version 4 sn} Won | Two [Wed] Tu] Fa Sun operators insats| CY] Gl XP Eb et | Silty Check (6 = Good; $= Satstactonyi P= POOH (gate STA) MGS CAE TSE ye Ta ee ‘act [Nameplate (Capacity clealy marke) /papen nama we 7A [Cantos (Cleary marked iy operational aioe way ay 7 [ats Goda, Tal hs, Waring & Ree) [Lana 4 i n ft [Hert Opratoad tae L waite “AE | Reversing Warring Beeper(Operatona) | Tanda Mondor UA ‘Acé [TynesiNot Worn, Cul or Damaged) / Garpu Ww ete ‘7 [Overhead protection la placepelndung Kepala vw wide} [7 |e Nut Tight none missing) ur oda Creme Is 8 [Tyres{Not wom, cor damaged) /Ban ee et vel | et ‘A-10 [Brakes(Foot& Hand Brakes operational) # Ivins 71 [Storing Grlh-No Sack or pl / Sito Kano dat de ‘Ari? [Soaling(Frmiy allached, not damaged or woen) 7 Tempal Dudu UuueTet pee 2-1 Seat Bel ad oehing ysten(Opeatonay Sauk Pengaman Poet et [A-14 [Lin System (Operational) / Sistem Angkat Ye uvich -A-18 | Tt SysterOperatona /Sietom Ming Uefel cor _| 416 [asl Chas & cable operatona (Ting (ena Gan kab ery Eanes £47 | Transmision(Nolsppeg Teens (teak ergencr) Wee ce a-16 [Batlery(Connected and charged) / Batra (erhubung dan isl daya) tbet uit} tf 2-19 [Radar oa of ebratndaraged)/Raltor Gre) Wide ot cl 4-20)Ges Bote Connesedcerect, no eeing} Tang Gas ool oe [Se eee a a B+ |Cootng air lve Ar pendegin tela wd belt ol 3-2 [Brake id eel Miyake Crate 1. [Rydal allovl/ Mieke eT 4 [engine oie / Oi Mesa eu ole 6 | Transmission ol favel/Minyak tranemish the} Uh [Now pS aay rarAatlon Se OREO ESSN i p TALILNTAR : |FIM-SEA-OHS-003, Version 4 ea Gl Forklift Check List Font: MY Py’ Supervisor: HALILINTAR shat TTD Weak atnpoation 37] se BITENG . ion [Tuo [Wed] Taw] Fr | Sat | Sum porators nts Feit Hour Mtr Roding ] Safety Check (G = Good; $ = Satisfactory; 7 ie © ca ras Nap (pact cry ated) [paar rama Wade) SU] [Centro (Clearly marked fuy operation or uly Mitel ini each, a Ua, Waring & Reversing) apa Wate ed orn peraioad Kakson Ui et ee Reversing War BeepeOpeaioa) Toda Mandar Ate FinoiNal orn, Cul Donvaeid Gar Chi i fc [Ovehead plein npc pling hla COE [fe [nse Nuts igh none msing Mur oda Wad ht od [A fivestetworn eter does /on odd to [6rakstoo & Hand Bates operant . Gah Act |SlenngiSmeah- No Sucker pla) / Som Kemudl Gy wo a | Sela Fy aeched el daneged or wor} Templ Daath : wee 7a] Sal Bl ade system (Operatona Sain Fergaran dao oe ‘14 [cl System(Operallona)/ Sistem Angkat auctor ‘15 Tit Syslom(Operatonay/ Stem Wiring elo uous 2-1 itast(Gras & cable operatena ang (tial dan abe Ae [acr7|Trnsmsiono spn) Tran Wat leraeine i Cite Zia Batey(Connecte and chge} / Baer letbung dn nda) ae Oo 8-19 [Radiato{Glear of debderindemaged)/ Radiator (bersh) eld eue 7-20 as Bote (Cortected caret, nt lean) Tobung Gas a 3+ [Cootng walrtevel/ Ar ponding Ue ele 2 [era hd eve Wink rom cet bet 1:9 fiverae a evel” Minyek hace i ua eer ‘8-4 [Engine oi evel / Oi Mesin bo et eee rarenisin afl /injt Waren 4 |HUA ont: NUH Wook ofinspeetion: 1S 720 /2 3 Dopot CIBITUNG: Form Roteronco: OSH-6F-V7 (EM Use only) FMSEA-OHS-003, Version 4 Forklift Check List ‘Supervisor: HALILINTAR Mon [ Tue [Wed] Twa] Fei [Sat | Son peraors ina 0 he Forlt Hour Meter Reading Safety Check (G = Good; & = Satisfactory; P= Poor) A bork a eee a e fe | ’At [Nemeploe (Capac ceay marked) papan name (hs 14 ‘Az [Conve (Crary marked uly operational) etkaor ae og 13 [Ughts (Headghs, Taf Ugh, Warsi & Reversing) Lara whe of ‘x | OperaonayTKaoon weer ‘AS | Reversing Warning Geeper(Operalional/ Tanda Mundur LTA A | ‘Ko | Tynes (Wot Worn, Cu or Damaged) arpa oer ‘87 [Overhead protection in pave /petndung Kopala : UATE ‘A-8 [Wheel Nots(Tight -none missing) (tur vada ot Uul Yield “A [Test worn i er damaged) Ban Aer, Ato [BrokesiFoot& Hand Brakes operatona) Met vive ‘11 [SteoingSma0h- No Sack epla/Sem Kemucl Ube v a1 Seat Fem atcha et denogea or wo) Tempal Diaik Liven [15 [Seat ett na inietocking sysiem (Operalona)/ Sebuk Pongaman Peder 1:14 [System Operatnap Sten Angie ; Boe [a1 fit Sten Opeaiona Siton Mn ctit et 16 ites Ghain & cable operational) Tang (ania dan Kabah HH ree 17 | TranerassontNot sipping) Trani ek tergetinee) l it ‘18 |Batiory(Carnested and charged) / Baer tehubung dan 6 aya) oa 19 RacitoCear of aebristunderaged)/ Redaer bere) Vaea ares 20] Gas Bote Connected coecty, not leaking) Tobung Gas Bi nea 2s Me ee 8-1 [Cootng water level Ar pend Weve 2 [Beko tld eval nak rem ttl oie €.2 [Hysroule aleve Minyax naronc 1 Tete 2 [Greate OFM Satire [Transmission ol fevel / Minyak transmisi "A CMw oe Wook of nspoction: 22/2 ‘Depot: CIBITUNG Form Roforence: OSH.6F-V1 (EM Use oniy) Fork 2) FM-SEA-OHS-003, Version 4 Forklift Check List ‘Supervisor: HALILINTAR shi Wen Fa | sat [oan onoators ntas|_CAydn fol Fy Fol Hour Meter Reading Safety Chock (G = Good; 5 = Salstactory; P= Poor rae SC eS ee ee dct [Naneplte (Copeciy clearly marked) pepan name t tel tt et ‘82 [Contos (Cleary mated aly operational) /idkaer ch NAY ‘3 [Uahis(easigns, Tal Lge, Waring & Revering Lamu ae [hea [Mae(Operatona) /Kaison " + Se 75 [Reversing Warring Beeper(Operatna) Tanda Mund CA A [Tye on, Cut or Damaged) Sapa CAAA A ‘AT [Overneadproictn in pleco /plindung kepaa vl aul 78 [Wheat Nts Tig none missing) Hr oda a arte 7a [Tes etworn ekercamaged fGen if Aid fe} ‘NiO [Birckes(Foot & Hand Brakes oporatona) CG Ueicl [a1 |Steeng(Smoot No Slack or pa Siem Kemal Eee Tec ltl a:$2| Setna Femi ached nal damage wor) Tempe Duduk oon 'A-19 [Seal Belt and interlocking system (Operational) / Sabuk Pengaman CEM ALT ele Acta [it Ster(Operaon Sem Angkat Cte LiL ‘A-45|Tit Systen(Operatna) Sistem Ming Lo ‘hi6 |Mast(Ghoins & cabo oporetiona)/ Thing (vant dan be) ee ae te [Act7 [Twansmission(Nol sipping) Tranmt(ldak ergetncl) GeTeIeho 16 [Batey{ Connected od eharged) / Balers (iehubung dan a aya) Cle Cle 19 | RadiatrCieer of debrbvondamageg)/ Radiator (brs) UuULe Efe 20 [Gas Botle(Conntectad carly nol leaking) / Tabung Cae ul LI Gy aes eae 8-1 [Cooling water ove / A pending Z LclelT LC er 2 iene pe “Oh & Cf Port | 8:3 [yeraue ofteve Mina no See eee ee a 3. acini a an 4 eae inane ee i i HALILINTAR |Wook ofinepaction: 24-37 Mey t-3 fox Cots Depo: GlarTUNG 7 Form Roleronco: OSN-GF-V1 (EM Use only) Forklift Check List Gob 28 ae FUSEA-OHS-003, Version 4 ‘Operators inital Forilft Hour teter Reading! Tue Wed Thu] Fri | Set | Sun Safety Chock (9 = Goods § = Satistacto aes ere ree ‘Act |Nameplaie (Capacity cleary ‘Rcd | Convals (Crear marked uly cperabena) alr ‘Ad [Lights (Headlohts, Tal Lighls, Warning & Reversing) /Lampu ‘aod [Horn(Opevailonal Klakon [As [Reversing Warning Besper(Operatonal / Tanda Mundur ‘£6 | Fynea('ot Worn, Cul Damaged) / Oarpu ‘AT [Overhead protection in place pelindung kepada ‘8 [Wheat Nuis( Tight none missing) Mur oda 9 [TyeosiNot worn, er damaged) / Ban ‘A-10[Brakes(Foot& Hand Brakes operation) 'A-11 |StearngiSmooih- Ne Slack o play) Slatem Kemud [Ac¥2 [Seating(Feniy alochod, nol damaged or wom) / Tempat Duduk locking system (Operational /Sabuk Pengaman [a-13 {Seat Bett ana i [4-14 [Lit Sysiem (Operational) / Sistem Angkat [A-16 [Tk System(Operaiona) / Sistem Ming [8-16 |Mast(Chains & cable operational /Tiang (reniat dan kabel) 117 [Transinission(Notsipplng)/ Trannist (dak erga) 'A-18 [Baten Connected and charged) / Baler (terhubung dan si days) '6-19 | Radiotor(Glear of debrstundemaged) / Radiator (ara) a] >> lala falar |a fora Ja ]ojalalalrle|alalal: ala} ala|stale|a] ole) le lel alofafa) alala| 'a-20 [Gas Botle(Conntacted coveciy, not leaking) Tabung Gas Ennead 7/7 |7|9| 91 9/99 |a]a| ae] 9] «| o]¢]2] 9] 419. alalslelala]als|a]s)el=|2] ae |alo) lala! || > |a |] e]e1|a ero] [ro] a) alolsa ley) 18-1 [Coofng water lvel/ Air pandingin Bz [Brake tld level Winyak com |Hyérauie ol ovel/ Minyak hao [Engine on ievel7 OF Mesin 4olalela Tranarmion oll level/inyak tani BUT ARMOR olor la le fey ¢|3 |t lo] 9 9 ]olo|o sja\t lap HALILINTAR