PT DAICHINDO SUKSES Form Excavator

Inspection
MANDIRI
DATE :

ACCEPT ACCEPT WITH NOTE NOT ACCEPT

PERUSAHAAN : EQUIPMENT :

TAG NO. :

CLIENT : SERIAL NO. :

MODEL / TYPE :

LOCATION : ENGINE NO. :

MANUFACTURE : YEAR BUILT :

CONDITION
DESCRIPTION COMMENTS
YES NO

GENERAL
1. Body Condition & chassis
2. Engine Complete
3. Arm, Boom, Bucket
4. Cylinder Arm
5. Cylinder Boom
6. Cylinder Bucket
7. Bucket and Tooth
8. Hose and Clamp hydraulic
9. Hydraulic Pump
10. Hydraulic Valve
11. Swivel Joint
12. Transmission
13. Final Drive
14. Radiator &Fan and Safety Cover
15. Swing Motor
16. Swing Distributor
17. Hydraulic Pump
18. Track Train & Power Train
19. Upper Roller
20. Lower Roller
21. Alternator
22. Battery & Relay
23. Electric wire & Fuses
24. Rotary lamp
25. Counter Weight
26. Fire Extinguisher
27.Reverse Alarm
28. First Aid Kit

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 PT DAICHINDO SUKSES Form Excavator
Inspection
MANDIRI
DATE :

29. Hand Rail

30.Handle Control
31.Cabin ( Incl : Seat & Seat Belt )
32. Access Step
33. Working Lamp
34. Mirror
35. Instrument Panel
36. Wiper & Water Pump
37. Under Carriage
38. Dash board condition: - Gauge, - Meter
39. Running Test and Function Test

FLUID
40. Fuel Level
41. Engine Oil Level
42. Transmission Oil Level
43. Hydraulics Oil Level
44. Gear Box Oil Level

Remarks:

Inspected by, Checked by, Acknowledge by,

Safety Officer
Operator Mekanik SHE UOI

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