ROUGH TERRAINE CRANE INSPECTION FORM

Doc. No. 26071-JO-HSE-PMOB-050

Effective Date 08 February 2021
Revision No. 001

Contractor : PT. KOIN KONSTRUKSI JO Control Number :

Equipment Number : Model/Type :

Manufacture : Serial Number :

Engine : Date Inspection :

Hours Meter : Odometer :

Period of Inspection : Premob Third months Others

(S) INSPECTED AND SATISFACTORY (R) PREPAIRED AND OR ADJUSTED (X) REQUIRES RECHECK AND OR REPAIR

DOCUMENTATION OPERATOR & EQUIPMENT S R X

1 Original Manufacturer Name Plate with
Serial Number
2 Original or a Copy of Operation Manual
Book
3 MIGAS "SKPP" SILO Certificate
4 DEPNAKER "PPPAT" Certificate
Matches Unit Type -Series
5 SIO Government Operating Licence
(MIGAS) or Kemenaker

OPERATOR’S CAB S R X
1 Step, Door Handle, Latch
2 Seat, Seatbelt, Cleanliness
3 Windshield, Cab Glass
4 Windshield Wiper, Washer
5 Fan (Air Circulation)
6 Sun Visor
7 Speedometer
8 Tachometer
9 Audio, Visual Alarms
10 Indicators, Gauges
11 Switches
12 Mirrors, Rear, Left, Right

ELECTRICAL SYSTEM S R X
1 Headlights, Low / High Beam
2 Signal / Hazard Lights, Front Rear
3 Tail Lights, Brake Lights
4 Horn
5 Back Up Lights / Alarm
6 Flashing Light, Cab Mounted
7 Electrical System Wiring
8 Batteries, Covers, Hold Downs
9 Battery Terminals, Cables
 ROUGH TERRAINE CRANE INSPECTION FORM
Doc. No. 26071-JO-HSE-PMOB-050
Effective Date 08 February 2021
Revision No. 001

ENGINE S R X
1 Oil Leaks
2 Coolant Leaks
3 Fuel Leaks
4 Fan, Guards, Belts
5 Abnormal Exhaust Smoke
6 Exhaust System, Leaks, Silencer
7 Radiator, Leaks, Cap, Gasket

OPERATOR STATION S R X
1 Throttle Control
2 Brake Pedal
3 Transmission Controls
4 Outrigger Controls
5 Machine Level Indicator
6 Boom Hoist Control
7 Angle / Range Load Chart
8 Boom Angle indicator
9 Main Winch Control
10 Auxiliary Winch Control
11 Boom Extension Control
12 Swing & Brake Controls
13 Cab Swing Safety Lock
14 360 Degree Swing Lock
15 Rear Axle Oscillation Stop Locks

DRIVE TRAIN S R X
1 Front Axle Housing, Mounting Bolts
2 Steering Knuckles, Hubs, Spindles
3 Differential Planetaries, Seals, Leaks
4 Trunnion Bearings, Mounting Bolts
5 Rear Axle Housing, Mounting Bolts
6 Steering Knuckles, Hubs, Spindles
7 Differential Planetaries, Seals, Leaks
8 Trunnion Bearings, Mounting Bolts
9 Drives Shafts, Front, Rear
10 Transmission, Mountings, Seals, Leaks
11 Transfer Case, Mountings, Seals, Leaks
12 Torque Converter, Seal, Leaks
13 Torque Converter Drive Shaft

STEERING SYSTEM S R X
1 Steering Wheel, Linkage
2 Orbital Pump, Leaks
3 Control Valve, Steering Box, Oil Leaks
4 Follow Up Linkage
5 Steering Cylinders, Oil Leaks

BRAKE SYSTEM S R X
1 Air Hydraulic
2 Brake Chambers, Linings
3 Rotors, Pads, Callipers
 ROUGH TERRAINE CRANE INSPECTION FORM
Doc. No. 26071-JO-HSE-PMOB-050
Effective Date 08 February 2021
Revision No. 001

4 Brake Tubes, Hoses, Front, Rear

5 Brake Test,
6 Parking Brake, Test

UPPER STRUCTURE S R X
1 Boom Pedestal, Mounting bolts
2 Counterweight Mounting Bolts
3 Main & Auxiliary Winch Mountings
Swing Drive Motor & Brake, Noise,
4 Leaks
5 Hydraulic Hoses, Connections, Leaks
6 Compressed Air Lines, Connections, Leaks
7 Swing Gear, Bearing & Pinion

BOOM ASSEMBLY S R X
1 Boom Angle Indicator
2 Base Section Inspection
3 Mounting Pins, Locks, Grease Fittings
4 Intermediate Section Inspections
5 Tip Section Inspection
6 Inner Boom slides
7 Outer Boom Slides
8 Boom Internal Cables, Chains, sheaves
9 Hydraulic Hoses, Connections, Leaks
10 Point sheaves
11 Load Block sheaves, SWL
12 Load Block, Hook, Latch, SWL
13 Wire Rope Condition, Anchorages
14 Headache Ball, Hook, Latch, SWL

CRANE HYDRAULICS S R X
1 Boom Lift Cylinders, Leaks
1.1 Counterbalance Valves, Leaks
2 Boom Extension Cylinder, Leaks
2.1 Counterbalance Valve, Leaks
2.2 Mounting Pins, Locks, Grease Fittings
2.3 Hydraulic Tubes, Hoses, Connections, Leaks
3 Outrigger Cylinders, Rear, Leaks
3.1 Outrigger Cylinders, Front, Leaks
Outrigger Counterbalance Valves,
3.2 Leaks
3.3 Mounting Pins, Locks, Grease Fittings
3.4 Hydraulic Tubes, Hoses, Connections, Leaks
4 Main System
4.1 Hydraulic Pump, Leaks, Noise
4.2 Hydraulic Pump Manual Disconnect
4.3 Control Valves, Oil Leaks, Hoses
4.4 Hydraulic Tank, Oil Leaks, Cap, Seals
4.5 Tank Mountings, Straps
5 Hoist Motors
5.1 Main Hoist Motor, Brakes, Noise, Leaks
5.2 Auxiliary Hoist Motor, Brakes, Noise, Leaks
5.3 Hydraulic Tubes, Hoses, Connections, Leaks
 ROUGH TERRAINE CRANE INSPECTION FORM
Doc. No. 26071-JO-HSE-PMOB-050
Effective Date 08 February 2021
Revision No. 001

5.4 Friction drive clutch and brakes

5.5 Swivel Joint, Leaks

AIR SYSTEM S R X
1 Compressor, Oil Leaks, Pumping Oil
2 Air Tanks, Mountings, Safety Valve
3 Tubes, Hoses, Drain Valves

FUEL TANK S R X
1 Leaks, Cap, Gasket
2 Mounting Brackets, Straps
3 Fuel Lines, Connections, Leaks

SAFETY S R X
1 Engine Emergency Shutdown Switch
2 Outrigger Pads
3 Load Moment Indicator
4 LMI Manual
5 Operator’s Manual
6 Operator’s Daily Log Book
7 Anti-Two Block Alarm / Cut out
8 Over Boom Alarm / Cut out
9 Over Hoist Alarm / Cut out
10 Travel, Swing Audio Alarms
11 Fire Extinguisher, Capacity, Date
Charged

ENVIRONMENTAL S R X
Emergency Spill Kit

ACCESSORIES
1 Jib Boom S R X
2 Boom Point Extension
3 Pendant Lines

TIRES S R X
1 Front / Rear, Condition,
2 Front / Rear, matched
3 Wheels, Rims, Lock Rings
4 Mounting Nuts, Studs

TIRES SIZE PLY TYPE

PERCENTAGE LEFT

Front Rear

Comments:
Use additional Pages if necessary to describe findings indicated in “X” and “R” check boxes
 ROUGH TERRAINE CRANE INSPECTION FORM
Doc. No. 26071-JO-HSE-PMOB-050
Effective Date 08 February 2021
Revision No. 001

Date Inspection Completed :

Contractor Rep :
Badge :

Comment :

Inspection Status : Pass Hold Rejected

Inspected by

Inspector 1 Inspector 2 Owner/User