SAFETY HEALTH & ENVIRONMENTAL DEPT

PT. CABOT INDONESIA

WELDING ENGINE INSPECTION

Reference : Doc. No. Form - 011 Rev. 0

Date of Inspection Re-inspection

Equipment data : Operator data :

Registration Number Name

Manufacture Sex (male/female)

Serial Number Age

Capacity Position

Certificate Exp.

Subject : Welding engine ………

Result column : Yes/good, Acceptable X Not/Bad, Not To Use NA Not Applicable
Copy of Driving license, Operator certificate and Equipment certificate must be attached in this form

NO CHECK ITEM CHECK POINTS RESULT REMARKS

1 Welding engine
* Appearance / Structure Damage, Deffect
* Cooling system Water vol., V-belt, Fan
* Fuel system Pump, Pipe, Leakage
* Exhaust system Muffler, Sound
* Battery Liquid volume, Aging, Terminal
* Starter motor / Dynamo Function, Damage
* Breaker / Automatic stopper Function, Damage, Missing
* Meters ( ampere / volt meters) Function, Breakage
* Wheels Structure, Wheel stopper
* Grounding Resistance, Missing

2 Cable / Connector
* Supply cables Quality, Capacity, Damage
* Earth (return) cable Quality, Capacity, Damage
* Cable connectors Water-proof, Damage
* Cable terminals / Clamp Damage, Secure, missing

3 Misscellaneous
* Safe guard for moving part

Comments :

Inspected by,

( __________________ ) ( __________________ )
Electric Spv / In charge Mech.Spv./ In charge.

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