PT WIDI JAYA ANGGUN

TOOLS & EQUIPMENT INSPECTION CHECKLIST

CRANE AND LIFTING EQUIPMENT

[Subjects] □ Truck Crane □ Crawler Crane □ Tower Crane □ Vehicle with Crane □ Side Boom
Result Column (Ö ): Yes/Good, Acceptable, (X): Not/Bad, Not to use, (NA): Not applicable
EQUIPMENT CARRY-IN CERTIFICATE
Type : Police No. :
Machine No : Certificate No :
Serial No. : Certificate Validity :
Capacity : Operator Name :
Manufacturer : Operator License :
Subcontractor : Operator License Validity :
Date of Inspection : Validity of Inspection :
Place of Inspection : Type of Inspection High Risk / 3
Monthly
Month
This form must be completed by the operator and company user before entering the equipment to be operated in the
site project area, and at any time of setting location. All equipment condition must meet to the Safety Regulation and
GTU Management Plan

I Lower Structure : Yes No N/A VII Outrigger : Yes No N/A

1 Crawler Type : 1 Stabilizer Box :
2 Crawler : 2 Outrigger Beam :
3 Upper Roller : 3 Jack Cylinder :
4 Lower Roller : 4 Outrigger Shoe :
5 Crawler Adjust : 5 Weld Joint :
6 Frame :
7 Drive Gear Box : Hydraulic Component
8 Drive Chain and Gear : 6 Hydraulic Pump :
9 Weld Joint : 7 Hydraulic Lines :
8 Hydraulic Cylinder :
II Wheels and Titer : Yes No N/A 9 Hydraulic Tank :
1 Wheels : 10 Hydraulic Filter :
2 Tires :
Main Load Hoist
3 Axle Lock : VIII : Yes No N/A
Winch
4 Propeller Shaft : 1 Drum :
5 Spare Tires : 2 Brake Shoe and Lining :
3 Clutch Lining :
III Turn Table : Yes No N/A 4 Pushing Cylinder :
1 Slewing Ring Bearing : 5 Ratchet :
2 Cone Roller :

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Form/2/Crane & Lifting Equipment
 PT WIDI JAYA ANGGUN

TOOLS & EQUIPMENT INSPECTION CHECKLIST

CRANE AND LIFTING EQUIPMENT

Aux. Load Hoist

3 Weld joint :
Winch
4 Turn Table Gear : 6 Drum :
5 Swing Gear : 7 Brake Shoe and Lining :
8 Clutch Lining :
IV Upper Structure : Yes No N/A 9 Pushing Cylinder :
1 Mast Boom : 10 Ratchet :
2 Gantry Connection :
3 Boom Stopper : IX Boom Hoist Winch : Yes No N/A
4 Counter Weight Assy : 1 Clutch Lining :
5 Boom Pivot : 2 Clutch Housing :
3 Brake Shoe and Lining :
V Telescopic Boom : Yes No N/A 4 Planetary Gear :
1 Main Boom : 5 Ratchet :
2 Telescopic Section : :
3 Head Sheave : X Aux. Boom or Fly Jib : Yes No N/A
4 Boom Pivot : 1 Main Cord. :
5 Sliding Wear Pad : 2 Brace or Lacing :
6 Lift Cylinder Mounting : 3 Head Sheave :
4 Sheave Guard :
5 Boom Connector :
VI Pneumatic Component : Yes No N/A
1 Compressor :
2 Tank and Safety Valve :
3 Pressure :
4 Lines :
5 Control Valve :
6 Air Cleaner :
VII Wire Rope : Yes No N/A XVI Hook Block : Yes No N/A
1 Mast Boom : 1 Sheaves :
2 Main Load Hoist : 2 Hook Nut and Bearing :
3 Boom Hoist : 3 Hook :
4 Upper Pendant Rope : 4 Safety Latch :
5 Insert Pendant Rope : 5 Anti to Block :
VIII Aux. Boom : Fly Jib :
6 Aux. Load Hoist : 6 Weight Ball :
7 From Pendant Rope : 7 Swivel Bearing :

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Form/2/Crane & Lifting Equipment
 PT WIDI JAYA ANGGUN

TOOLS & EQUIPMENT INSPECTION CHECKLIST

CRANE AND LIFTING EQUIPMENT

8 Rear Pendant Rope : 8 Hook :

9 Safety Latch
Machine
XII : Yes No N/A : Yes No N/A
1 Starting Motor : 9 Bolting :
2 Battery and Wire : 10 Engine Mounting :
3 Wiring System : 11 Engine Guard :
4 Charging System : 12 Turbo Charges :
5 Fueling System : 13 Fueling Lines :
6 Lubricating System : 14 Water Leaking :
7 Cooling System : 15 Oil Leaking :
8 Oil Filter and Air Filter : 16 Fuel Leaking :
Indicator System
XIII : Yes No N/A : Yes No N/A
1 Tachometer : 5 Oil Pressure :
2 Traveling Lamps : 6 Hydraulic Oil Pressure :
3 Traveling Alarm : 7 Air Pressure :
4 Water Cooling : 8 Ampere Meter :

XIV Support Tools : Yes No N/A XVII PPE : Yes No N/A

1 Operator Cabin : 8 Safety Hat :
2 Doors and Window : 9 Safety Shoes :
3 Wiper : 10 Safety Glass :
4 Horn : 11 Hand Glove :
5 Mirror : 12 Dust Mask :
6 Wire Rope : 13 Ear Protector / Plug :
7 Shackle :
Safety Devices
XV : Yes No N/A : Yes No N/A
1 Safe Load Indicator : 7 Aux. Hoist Limiter :
2 Load Chart : 8 Swing Limiter :
3 Moment Load Limiter : 9 Boom Hoist Limiter :
4 Weight Indicator : 10 Level Indicator :
5 Angle Indicator : 11 Disconnect Switch :
6 Main Hoist Limiter : 12 Fire Extinguisher :

Inspector Instruction:
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Form/2/Crane & Lifting Equipment
 PT WIDI JAYA ANGGUN

TOOLS & EQUIPMENT INSPECTION CHECKLIST

CRANE AND LIFTING EQUIPMENT

Inspection Result:
NOT SAFE to Operate SAFE to Operate

Inspected By: Reviewed By Approved By:

Mechanic / Operator HSE SPV

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Form/2/Crane & Lifting Equipment