Light Vehicle Pre-Operation Check Sheet

Daily 2 0 24 7

Inspection Number 14909360 Customer Name PT TRAKINDO UTAMA

Serial Number DB1163 Completed On 11/5/2023 9:01:09 AM
Make DAIHATSU Inspector Yeremia Rudolf Kristian
Model XENIA PDF Generated On 11/5/2023
Equipment Family UTILITY VEHICLE SMU 146554 Kilometers
Location Kecamatan Pulau Gebe, Maluku Utara Coordinates 107.900001525879, -
0.0730836,
129.4239068
Technician

General Info & Comments

General info/Comments NORMAL

Item to be inspected for Machine

1.1 Vehicle body, windshield and window glass, doors, mirrors and footsteps GOOD
(P2)

1.2 All wheels (tires, rims, nuts, and bolts) (P1) BAD
Comments: Tire RH rear aus

1.3 Rear/front axle and springs (leaks or damages) (P2) GOOD

1.4 Passenger seat belts (P2) GOOD

1.5 Windshield and Window Glasses (P2) GOOD

1.6 All working lights and signals (front/rear) (P1) BAD

Comments: Brake lamp RH rear tidak menyala

1.7 Light bar, strobe lights, and buggy whips (P2) NA

1.8 Bumper/bullbar (front/rear) (P2) NA

Form Order Report Serial Number : DB1163 Page 1 of 3

 1.9 Engine oil level (P1) GOOD

1.10 Engine coolant level (P1) GOOD

1.11 Brake fluid level (P1) GOOD

1.12 Power steering and Clutch oil level (P1) GOOD

1.13 Radiator, fan, and fan belt (leakages or damages) (P1) GOOD

1.14 Battery (bracket and connections) (P1) GOOD

1.15 Air snorkel (P2) GOOD

1.16 Mirrors (P2) GOOD

1.17 Operator seat belt (P1) GOOD

1.18 Horn (P1) GOOD

1.19 Monitoring display system, panel indicators, alarm and gauges (P1) GOOD

1.20 Transfer case position (4L for HL) (P1) NA

1.21 Parking brake (P1) GOOD

1.22 Service brake (P1) GOOD

1.23 Transfer case position (2H for LL) (P1) NA

1.24 Steering wheel (P1) GOOD

1.25 Wiper and washer (P2) GOOD

Form Order Report Serial Number : DB1163 Page 2 of 3

 1.26 Fire Extinguisher/APAR (P1) GOOD

1.27 Two Way Radio (P2) NA

1.28 Heater/AC (P2) NA

Item to be inspected for Driver

2.1 Are You taking drugs that can cause drowsiness? (P1) NO

2.2 Are You in good health and fit to drive (P1) YES

2.3 Available spill Kit (special for Field Service) (P2) N/A

Item Damage Report

3.1 If any damage found, please describe the type of damage NORMAL

Form Order Report Serial Number : DB1163 Page 3 of 3