No Form

Issued Date
PREVENTIVE MAINTENANCE REPORT BELT CONVEYOR Revision
Rev. Date
PT. ABADI AGROSINDO PERSADA - KRIAN Page

Equipment Number : Prosedure Code :

Description : Record Retention Time : 1ˢᵗ Year
Area : Note :N = Normal ; Y = Pergantian / Perbaikan
Supervisor : N/A = Not Available (Tidak tersedia) ; RH = Running Hours
PM dilakukan setiap RH 2000 jam, RH 4000 jam, RH 6000 jam, RH 8000 jam

"SAFETY AND HEALTH INSTRUCTION"

1. Pastikan equipment sudah schedule preventive maintenance
2. Pastikan power sudah di off kan (LOTO).
3. Pastikan bahwa equipment bisa di PM, tidak ada tekanan pada line/vessel.
4. Pastikan fluida sudah di drain/material sudah di singkirkan dari equipment.
5. Sebelum melakukan kerja permit harus di urus terlebih dahulu.
6. Gunakan APD dan alat keselamatan kerja yang diperlukan.

BELT NORMAL ABNORMAL REPAIRING REMARKS

1 TOP BELT

2 BOTTOM BELT

ROLLER

1 CARRY

2 RITTEN

3 IMPACT

4 GET ROLLER

BELT CLEANER

1 PRIMARY

2 SECONDARY

3 V-PLOW

4 SKIRT RUBBER
PULLEY LEFT (°C) RIGHT (°C) REMARKS

1 DRIVE
2 TAIL PULLEY
3 SNAP / BEAN PULLEY 1
4 SNAP / BEAN PULLEY 2
5 TAKE UP
FRONT (°C) REAR (°C) OIL REMARKS
MOTOR
GEARBOX

Date:____________________ Date:_______________________ Date:_______________________ Date:_____________________

Inspection By, Inspection By, Inspection By, Inspection By,

( ) ( ) ( ) ( )
MTC. PM 3 month MTC. PM 6 month MTC. PM 9 month MTC. PM 12 month
Checked By, Checked By, Checked By, Checked By,

( ) ( ) ( ) ( )
MTC. Supervisor MTC. Supervisor MTC. Supervisor MTC. Supervisor
Acknowledge By, Acknowledge By, Acknowledge By, Acknowledge By,

( ) ( ) ( ) ( )
User Supervisor User Supervisor User Supervisor User Supervisor