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RIWAYAT REVISI
REVISION HISTORY

REV TANGGAL URAIAN DISIAPKAN OLEH DITINJAU OLEH DISETUJUI OLEH

REV DATE DESCRIPTION PREPARED BY REVIEWED BY APPROVED BY
Pertama diterbitkan
00 07/12/11 Gunawan Slamet Riyadi Dewi Yuliana
First Issued
Penerbitan kedua
01 29/11/13 Muhamad Irfan Bagus Tri Atmoyo Dewi Yuliana
Second Issued
Perubahan Logo Perusahaan
Company Logo Changing
Perubahan nomor identifikasi dokumen
Changing of Document ID No.
02 12/11/14 Muhamad Irfan Bagus Tri Atmoyo Dewi Yuliana
Perubahan dua bahasa (Bahasa Indonesia &
Bahasa Inggris)
Change to dual language (Bahasa Indonesia
& English)
Perubahan Logo Perusahaan
03 21/01/15 Muhamad Irfan Bagus T Atmoyo Dewi Yuliana
Company Logo Changing
Penambahan Departemen GA pada daftar
04 01/10/15 distribusi Andre A Roby Syahputra Dewi Yuliana
Add GA Department on distribution list
04 December
05 Upgrading 9001:2015 Dian Pratama Roby Syahputra Dewi Yuliana
2017

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DAFTAR DISTRIBUSI
DISTRIBUTION LIST

DISTRIBUTION NO. STATUS DEPARTMENT PIC

01 Original QHSE QHSE Manager
02 Controlled Copy NDT NDT Manager
03 Controlled Copy HT HT Manager
04 Controlled Copy HR-GA HR-GA Manager
05 Controlled Copy FINANCE FINANCE Manager
06 Controlled Copy LOGISTIC LOGISTIC Manager
07 Controlled Copy BD BD Manager
08 Controlled Copy Branch Office Branch Manager

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DAFTAR ISI
CONTENTS LIST

KLAUSUL KETERANGAN HALAMAN

CLAUSE DESCRIPTION PAGE
1.0 TUJUAN 05
PURPOSE
2.0 RUANG LINGKUP 05
SCOPE
3.0 ACUAN 05
REFERENCE
4.0 DEFINISI 05
DEFINITION
5.0 TANGGUNG JAWAB 05
RESPONSIBILITY
6.0 URAIAN 07
DESCRIPTION
7.0 LAMPIRAN 10
APPENDIX
8.0 REKAMAN 10
RECORD
Lampiran. 1 Formulir permohonan perbaikan, CAST/IV/SM/12-01 11
Appendix. 1 Repair request form, CAST/IV/SM/12-01
Lampiran. 2 Formulir laporan perbaikan, CAST/IV/SM/12-02 12
Appendix. 2 Report repair Form, CAST/IV/SM/12-02
Lampiran. 3 Formulir daftar riwayat perbaikan tahunan, CAST/IV/SM/12-03 13
Appendix. 3 Form A list of annual repair history, CAST/IV/SM/12-03
Lampiran. 4 Formulir permohonan pelimbahan peralatan, CAST/IV/SM/12-04 14
Appendix. 4 Application forms cesspool equipment, CAST/IV/SM/12-04
Lampiran. 5 Formulir daftar peralatan yang dilimbahkan, CAST/IV/SM/12-05 15
Appendix. 5 Form Equipment list to be waste, CAST/IV/SM/12-05

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1. TUJUAN
PURPOSE
1.1. Untuk menjamin setiap peralatan yang rusak atau tidak berfungsi dengan baik tidak digunakan
dalam kegiatan inspeksi.
To ensure the equipment is damaged or does not function properly is not used in inspeksi.1.1
activities. To ensure the equipment is damaged or does not function properly is not used in the
inspection activities.
1.2. Untuk menjamin setiap peralatan yang rusak atau tidak berfungsi dengan baik ditangani secara
benar dan efektif.
To ensure the equipment is damaged or not functioning properly handled properly and effectively.

2. RUANG LINGKUP
SCOPE
2.1. Prosedur ini mencakup tata cara penanganan peralatan yang rusak atau tidak berfungsi dengan
baik mulai dari ditemukannya kondisi tersebut, penelusuran kerusakan, tindakan perbaikan hingga
keputusan penggunaan kembali atau pelimbahan sesuai dengan standar maupun peraturan
perundangan yang berlaku.
These procedures include procedures for handling equipment that is damaged or not functioning
properly ranging from the discovery of the condition, the search damages, corrective actions to
reuse or cesspool decision in accordance with the standards and regulations that apply.

3. ACUAN
REFERENCE
3.1. ISO 17020:2012
3.2. ISO 9001:2015
3.3. QM-07 Support R5
3.4. Manual Inspeksi CAST/I/SM02

4. DEFINISI
DEFINITION
Tidak ada
Nothing

5. TANGGUNG JAWAB
RESPONSIBILITY
5.1. Manajer NDT/HT
NDT manager
5.1.1. Mengetahui informasi peralatan yang rusak atau tidak berfungsi dengan baik. Informasi
diterima dari Supervisor NDT/HT, informasi langsung dari inspektur/Teknisi atau staff
logistik (asset, store, atau maintenance).
Knowing information equipment damaged or not functioning properly. Information
received from NDT/HT Supervisor, direct information from the inspector/Technician or
logistics staff (assets, store, or maintenance).
5.1.2. Mengkaji permohonan perbaikan, menyeutujui atau tidak.
Assessing the repair request, approve or not.
5.1.3. Mengkaji ulang laporan perbaikan, menyetujui atau tidak.
Reviewing the report repair, approve or not.

5.2. Supervisor NDT/HT

NDT Supervisor
5.2.1. Mengetahui informasi peralatan yang rusak dari inspektur/teknisi dan menyampaikannya
kepada manajer NDT/HT.
Knowing the damaged equipment information from inspectors/technician and submit it to
the manager NDT/HT.

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5.2.2. Memastikan kondisi peralatan yang rusak.

Ensuring conditions damaged equipment.
5.2.3. Menyampaikan ke staff asset informasi peralatan yang rusak
Convey to staff the information assets of damaged equipment
5.2.4. Mengetahui permohonan perbaikan peralatan yang rusak
Knowing request repair of damaged equipment
5.2.5. Melakukan pengujian peralatan yang telah diperbaiki, memutuskan untuk dilakukan
perbaikan ulang atau memutuskan bahwa peralatan sudah kembali berfungsi dengan
baik.
Testing equipment has been repaired, decided to re-do repairs or decide that the
equipment is returned to function properly.
5.2.6. Mengetahui laporan perbaikan peralatan yang rusak.
Knowing report repair damaged equipment.

5.3. Inspektur/Teknisi
Inspector/Technician
5.3.1. Melaporkan kepada supervisor NDT/HT tentang kondisi peralatan yang rusak.
Reporting to the NDT/HT supervisor about the condition of the damaged equipment
5.3.2. Bersama supervisor NDT/HT, memastikan kondisi peralatan yang rusak.
Together NDT/HT supervisor, ensure the condition of damaged equipment.
5.3.3. Bersama supervisor NDT/HT, melakukan pengujian ulang peralatan yang telah diperbaiki.
Together supervisor NDT/HT, repeated testing equipment has been repaired.
5.3.4. Memberi saran kepada supervisor dalam mengambil keputusan apakah perlu dilakukan
perbaikan ulang terhadap peralatan tersebut atau menyatakan peralatan tersebut sudah
kembali berfungsi dengan baik.
Advise the supervisor in making decisions whether to re repairs to the equipment or the
states of the equipment is back function properly.

5.4. Staff Asset

5.4.1. Melakukan pengubahan status peralatan pada daftar peralatan.
Make changes to the status of the equipment in the equipment list.
5.4.2. Mengajukan permohonan perbaikan kepada manajer NDT/HT yang diketahui oleh
supervisor NDT/HT.
Applying for improvements to the manager who is known by the supervisor NDT
5.4.3. Menerima salinan laporan perbaikan dari staff maintenance.
Receive a copy of the report improvement of maintenance staff.
5.4.4. Menginformasikan kepada supervisor NDT/HT tentang isi laporan perbaikan.
Inform supervisor of the contents of the report NDT/HT repair.

5.5. Staff Store

5.5.1. Memisahkan peralatan yang rusak dari peralatan yang masih berfungsi dengan baik di
dalam tempat peyimpanan atau store.
Separating the damaged equipment from the equipment is functioning properly in the
storage place or store.
5.5.2. Memberikan tanda bahwa peralatan tersebut sedang dalam kondisi rusak dan tidak bisa
dioperasikan.
Provide a sign that the equipment is in poor condition and cannot be operated.
5.5.3. Meletakan peralatan yang tidak bisa diperbaiki ke area pelimbahan atau disposal.
Laying equipment cannot be repaired to the cesspool or disposal area.
5.5.4. Meletakkan peralatan yang telah selesai diperbaiki ke area selesai perbaikan atau after
repair.
Laying equipment has been repaired to the finish area after repair or repair.
5.5.5. Menginformasikan kepada staff asset bahwa peralatan sudah selesai diperbaiki atau
peralatan masuk dalam kategori dilimbahkan.

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Inform staff of the assets that the equipment has been repaired or equipment included in
the category to be waste.

5.6. Staff Maintenance

5.6.1. Melengkapi permohonan perbaikan yang disiapkan oleh staff asset.
Completing the repair request prepared by the staff of the asset
5.6.2. Menentukan bisa tidaknya peralatan diperbaiki.
Can determine whether or not the equipment repaired
5.6.3. Menentukan perkiraan lama waktu perbaikan.
Determine the approximate length of time of repair.
5.6.4. Menentukan metode perbaikan.
Determine methods improvements.
5.6.5. Menyusun laporan perbaikan yang diketahui oleh supervisor NDT/HT dan disetujui oleh
manajer NDT/HT.
Prepare reports on improvements that are known by the supervisor and approved by the
manager NDT/HT.
5.6.6. Turut serta dalam pengujian peralatan yang telah diperbaiki bersama supervisor NDT/HT
dan atau inspektur/Teknisi.
Participated in the testing equipment that has been repaired along NDT/HT supervisor or
inspector/Technician
5.6.7. Melakukan perbaikan ulang bila hasil pengujian menyatakan peralatan perlu untuk
diperbaiki ulang.
Make improvements to reset when the test results stated equipment needs to be repaired
again.
5.6.8. Mengajukan permohonan pembelian bila perlu, sesuai dengan metode perbaikan yang
dipilih.
Applying for a purchase if necessary, in accordance with the repair method chosen
5.6.9. Menyerahkan peralatan yang telah selesai diperbaiki (dengan catatan laporan perbaikan
telah disetujui oleh manajer NDT/HT) kepada staff store.
Submit the equipment has been repaired (the report notes improvements have been
approved by the manager NDT/HT) to the store staff.

5.7. Staff Pembelian atau Purchasing.

Staff Purchasing
5.7.1. Melakukan proses pembelian sesuai dengan permintaan staff maintenance.
Purchasing process in accordance with the request maintenance staff

6. URAIAN
DESCRIPTION
6.1. Ketetapan
Provision
6.1.1. Permohonan perbaikan hanya dapat diajukan bila ada informasi peralatan rusak atau
tidak berfungsi dengan baik dari supervisor NDT/HT.
Request repairs may only be submitted if there is information equipment damaged or not
functioning properly from NDT/HT supervisor.
6.1.2. Perbaikan dapat dilakukan bila permohonan perbaikan disetujui oleh manajer NDT/HT.
Improvements can be made if the request is approved by the manager NDT/HT repair.

6.2. Langkah Penanganan Peralatan yang Rusak

Step Handling Equipment Damaged
6.2.1. Inspektur saat mengetahui peralatan tersebut rusak atau tidak berfungsi dengan baik
segera memberitahukan kepada supervisor NDT/HT.
Inspector to know the equipment is damaged or not functioning properly immediately
notifies the supervisor of NDT/HT.

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6.2.2. Inspektur bersama supervisor NDT/HT memastikan kondisi peralatan tersebut bahwa
benar dalam keadaan rusak atau tidak berfungsi dengan baik.
NDT Inspector joint supervisor ensure that the correct condition of the equipment in
disrepair or not functioning properly.
6.2.3. Supervisor NDT/HT menginformasikan kepada staff asset dan Manajer NDT/HT tentang
kondisi peralatan tersebut.
NDT/HT Supervisor informs staff and managers assets NDT/HT about the condition of the
equipment.
6.2.4. Staff asset mengubah status peralatan tersebut di dalam daftar peralatan
(CAST/IV/SM/12-01) menjadi “sedang dalam masa perbaikan” atau “under
repair/maintenance”. Pelapor mengisi formulir permohonan perbaikan, diserahkan ke
staff asset, diketahui oleh supervisor NDT/HT yang kemudian dimintakan persetujuan
kepada manajer NDT/HT (CAST/IV/SM/12-01) dan apabila user/manager NDT/HT tidak
ada ditempat persetujuan dapat via Telpon/Email. Rekaman tersebut setidaknya berisi:
Staff asset change the status of the equipment in the equipment list (CAST / IV / SM / 12-
01) to "being in a period of improvement" or "under repair / maintenance". Rapporteurs
fill application form improvement, submitted to the staff of assets, known by NDT
supervisor who then seek approval to the manager NDT (CAST/IV/SM/12-01). And if user /
manager of NDT / HT is not available in place of approval can be via phone / email the
recording contains at least:
a. Informasi peralatan (nama, model, penggunaan, nomor seri, tanggal kalibrasi, dll.
Equipment information (name, model, usage, serial number, calibration date, etc
b. Informasi kerusakan
Information damage
6.2.5. Staff asset meneruskan rekaman tersebut ke staff maintenance, peralatan diserahkan ke
staff store untuk disimpan.
Staff asset forward the footage to the maintenance staff, equipment handed over to the
store staff for safekeeping.
6.2.6. Staff store menyimpan peralatan tersebut dengan cara memisahkannya dari peralatan
yang masih berfungsi dengan baik (diletakkan di repair/maintenance area) dan memberi
tanda “tidak boleh dioperasikan” atau “Do Not Operate”.
Staff stores keep such equipment by separating it from the equipment is functioning
properly (put in repair / maintenance area), and mark it "should not be operated" or "Do
Not Operate".
6.2.7. Staff maintenance mengecek kondisi peralatan guna menentukan:
Maintenance staff to check the condition of the equipment in order to determine:
a. Keputusan apakah peralatan tersebut masih dapat diperbaiki dan dapat berfungsi
kembali dengan baik atau tidak.
The decision whether the equipment can be repaired and continue to function
properly or not.
b. Perkiraan lama waktu pengerjaan bila dapat diperbaiki.
Estimated long processing time when it can be repaired.
c. Metode perbaikan yang berisi tiga pilihan, yaitu:
Repair method contains three options, namely:
1). Perbaikan sendiri tanpa penggantian spare part/komponen.
Repair it without replacement spare parts / components.
2). Perbaikan sendiri dengan penggantian sparepart/komponen.
Repair itself with the replacement of spare parts / components.
3). Perbaikan oleh pihak ketiga.
Repair by a third party.
6.2.8. Bila tidak dapat diperbaiki maka maintenance staff membuat laporan perbaikan
(CAST/IV/SM/12-02) bahwa peralatan tersebut tidak bisa diperbaiki dan harus
dilimbahkan. Staff store mengajukan permohonan pelimbahan (CAST/IV/SM/12-04),
diketahui oleh superisor NDT/HT dan disetujui oleh Manajer NDT/HT. Setelah disetujui,
diberi tanda “Dilimbahkan” atau “Disposal” pada peralatan tersebut hingga peralatan

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tersebut dapat dilimbahkan sesuai dengan standar dan peraturan perundang-undangan

yang berlaku. Staff asset mengubah kondisi mengeluarkan nama peralatan tersebut dari
daftar peralatan (CAST/IV/SM/10-01) ke daftar peralatan yang telah dilimbahkan atau
“Disposed Equipment” (CAST/IV/SM/12-05), diketahui oleh supervisor NDT/HT dan
disetujui oleh Manajer NDT/HT.
If it cannot be repaired, the maintenance staff makes repairs report (CAST/IV/SM/12-02)
that the equipment cannot be repaired and must be waste. Staff stores apply cesspool
(CAST/IV/SM/12-04), known by supervisor NDT and approved by the Manager. Once
approved, marked "Waste" or "Disposal" on the equipment until the equipment can be
waste accordance with the standards and regulations in force. Staff asset change state
released the names of the equipment from the equipment list (CAST / IV / SM / 10-01) to
the list of equipment that has be waste or "disposed Equipment" (CAST/IV/SM/12-05),
known by the supervisor and approved by the Manager NDT/HT.
6.2.9. Bila dapat diperbaiki maka maintenance staff memasukan perkiraan lama waktu
pekerjaan dan metode perbaikan ke dalam permohonan perbaikan (CAST/IV/SM/12-01),
menyampaikannya ke manajer NDT/HT dan staff asset.
When the maintenance staff can be improved then enter the approximate length of time
the work and methods of repair to the repair request (CAST/IV/SM/12-01), submit it to the
manager and staff NDT/HT assets.
6.2.10. Untuk pilihan metode perbaikan sendiri dengan penggantian sparepart/komponen dan
metode perbaikan oleh pihak ketiga, staff maintenance mengajukan permohonan
pembelian komponen sesuai dengan prosedur pembelian CAST/II/SM/11.
For the preferred method of repair it with replacement spare parts / components and
methods of repair by a third party, maintenance staff to apply for the purchase of
components in accordance with the purchase procedure CAST / II / SM /11.
6.2.11. Setelah selesai diperbaiki, dilakukan pengujian peralatan oleh pengguna (dalam hal ini
inspektur didampingi supervisor NDT/HT). Bila belum berfungsi dengan baik, maka
dilakukan proses perbaikan kembali.
After completion of repair, testing equipment by the user (in this case accompanied by a
supervisor NDT/HT inspector/Technician). If it is not functioning properly, then the repair
process is carried back.
6.2.12. Proses perbaikan dan pengujian maksimal dilakukan tiga kali, lebih dari itu, maka
peralatan dinyatakan tidak bisa diperbaiki dan harus dilimbahkan.
Process improvement and maximum testing performed three times, more than that, and
then the equipment cannot be repaired and declared to be waste.
6.2.13. Bila dalam pengujian membuktikan peralatan tersebut sudah berfungsi dengan baik,
dinyatakan secara tertulis oleh pengguna dalam laporan perbaikan (CAST/IV/SM/12-02),
maka staff maintenance menyerahkan kembali peralatan tersebut ke staff store untuk
diletakkan di area “Selesai Perbaikan” atau “After Repair”.
If the test proves that the equipment is functioning properly, otherwise in writing by the
user in the report repair (CAST/IV/SM/12-02), the maintenance staff shall return the
equipment to the store staff to be placed in the area "Finish Repair "or" After Repair ".
6.2.14. Staff maintenance melengkapi laporan perbaikan (CAST/IV/SM/12-02) dan meminta
persetujuan dari manajer NDT/HT. Setelah disetujui, staff maintenance menyerahkan
salinan laporan tersebut ke staff asset dan mengisi daftar riwayat perbaikan tahunan
(CAST/IV/SM/12-03) yang dijaga kemutakhirannya, diketahui oleh supervisor NDT/HT dan
disetujui oleh Manajer NDT/HT.
Maintenance staff complete the repair report (CAST/IV/SM/12-02) and ask for the
approval of NDT/HT manager. Once approved, maintenance staffs submit a copy of the
report to the staff of the assets and charge an annual repair history list (CAST/IV/SM/12-
03) were maintained the sophisticated, known by the supervisor and approved by the
Manager NDT/HT.
6.2.15. Staff asset mengubah status peralatan dalam daftar peralatan (CAST/IV/SM/10-01) dari
“sedang dalam masa perbaikan” atau “under repair/maintenance” menjadi “lokasi

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penyimpanan peralatan”. Staff asset menginformasikan kepada supervisor NDT/HT

bahwa peralatan tersebut siap untuk digunakan.
Staff asset change the status of the equipment in the equipment list (CAST / IV / SM/ 10-
01) of "being in a period of improvement" or "under repair / maintenance" to "storage
location of equipment". Staff assets NDT/HT supervisor informs that the equipment is
ready for use.

7. LAMPIRAN
APPENDIX
7.1. Lampiran 1. Formulir permohonan perbaikan, CAST/IV/SM/12-01.
Appendix 1. The application form for repair, CAST/IV/SM/12-01
7.2. Lampiran 2. Formulir laporan perbaikan, CAST/IV/SM/12-02.
Appendix 2. Repair reports Form, CAST/IV/SM/12-02.
7.3. Lampiran 3. Formulir daftar riwayat perbaikan tahunan, CAST/IV/SM/12-03.
Appendix 3. Form a list of annual repair history, CAST/IV/SM/12-03.
7.4. Lampiran 4. Formulir permohonan pelimbahan peralatan, CAST/IV/SM/12-04.
Appendix 4. The application form cesspool equipment, CAST/IV/SM/12-04.
7.5. Lampiran 5. Formulir daftar peralatan yang dilimbahkan, CAST/IV/SM/12-05.
Appendix 5. Form a list of equipment that to be waste, CAST/IV/SM/12-05.

8. REKAMAN
RECORD

Nama Rekaman Lokasi Penyimpanan Masa Simpan (Tahun)

No.
Name of Recording Storage Location Storage Period (Years)
1 Permohonan Perbaikan Bag. Logistik
3
Repair Request Logistic
2 Laporan Perbaikan Bag. Logistik
3
Repair Report Logistic
3 Daftar Riwayat Perbaikan Tahunan Bag. Logistik
3
List History Annual Improvements Logistic
4 Permohonan Pelimbahan Bag. Logistik
3
Application cesspool Logistic
5 Daftar Riwayat Peralatan yang Dilimbahkan Bag. Logistik
3
List History Equipment to be waste Logistic

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Lampiran 1
Appendix 1
FORMULIR PERMOHONAN PERBAIKAN
APPLICATION FORM FOR REPAIR

Informasi Peralatan / Information Equipment

Nama / Name
Model
No. Seri/ Serial No.
Penggunaan/ Use
Tanggal Kalibrasi Terakhir/
Date of Last Calibration
Informasi Pelapor / Information Rapporteur
Nama / Name
Unit Kerja / Work Unit
Informasi Kerusakan / Damage information
Tanggal / Date
Lokasi / Location
Deskripsi / Description

Informasi Perbaikan **)

Repair Information **)
Bisa Diperbaiki? Bisa / Can
Can Be Repaired? Tidak Bisa / Cannot
Perkiraan Waktu Perbaikan
Estimated Time of Repair
Metode Perbaikan Perbaikan sendiri tanpa penggantian sparepart/komponen.
Repair methods Repair itself without replacement spare parts / components.
Perbaikan sendiri dengan penggantian sparepart/komponen.
Repair itself with the replacement of spare parts / components.
Perbaikan oleh pihak ketiga
Repair by third parties
Persediaan peralatan yang berfungsi Ada / available Jumlah (Unit)
dengan baik Tidak Ada / None Total (Units)
Inventory equipment is functioning
properly
Catatan/ Note

Pelapor/ Reporter Mengetahui/ Acknowledge by Disetujui oleh/ Approved by

Tanggal: Tanggal: Tanggal:

Date Date Date

No. Dokumen No. Rekaman *) Tanggal Dikeluarkan *)

Document No. Record No. *) Date Issued *)
CAST/IV/SM/12-01

*) Diisi oleh staff Asset / To be completed by the staff of Asset

**) Diisi oleh staff Maintenance/ To be completed by the staff of Maintenance

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HANDLING EQUIPMENT DAMAGED

Lampiran 2
Appendix 2
LAPORAN PERBAIKAN
REPAIR REPORT
Informasi Peralatan / Information Equipment
Nama / Name
Model
No. Seri/ Serial No.
Penggunaan/ Use
Tanggal Kalibrasi Terakhir/
Date of Last Calibration
Waktu Perbaikan / Time Repair
Tanggal Mulai Perbaikan/ Start Date Repair
Tanggal Selesai Perbaikan/ Date Completed Repair
Metode Perbaikan / Repair methods
Perbaikan sendiri tanpa penggantian sparepart/komponen./ Repair it without replacement spare parts / components.
Perbaikan sendiri dengan penggantian sparepart/komponen./ Repair itself with the replacement of spare parts / components.
Perbaikan oleh pihak ketiga / Repair by third parties

Tanggal Pengajuan Sparepart/ Filing Date Sparepart

Tanggal Diterima Sparepart/ Date Received Sparepart
Tanggal Pengajuan Perbaikan ke Pihak Ketiga
Filing date Improvements to Third Parties
Tanggal Diserahkan ke Pihak Ketiga
Date Submitted to Third Parties
Tanggal Diterima dari Pihak Ketiga
Date Received from Third Parties
Pengujian *) / Testing *)
Pengujian Catatan/Note Diuji oleh/Tested by Disaksikan oleh/Witnessed by
Pertama
First Tests

Tgl/ Date: Tgl/ Date:

Diperbaiki Kembali Tanggal
Corrected Return Date
Selesai Diperbaiki Tanggal
Done Corrected Date
Pengujian Catatan/Note Diuji oleh/Tested by Disaksikan oleh/Witnessed by
Kedua
Second Test

Tgl/ Date: Tgl/ Date:

Diperbaiki Kembali Tanggal
Corrected Return Date
Selesai Diperbaiki Tanggal
Done Corrected Date
Pengujian Catatan/Note Diuji oleh/Tested by Disaksikan oleh/Witnessed by
Ketiga
Third Test
Tgl/ Date: Tgl/ Date:
Dilimbahkan Tanggal/ Waste Date
Catatan/ Note

Diperbaiki oleh / Corrected by Mengetahui/ Acknowledge by Disetujui oleh/ Approved by

Tanggal: Tanggal: Tanggal:

Date Date Date
No. Dokumen No. Rekaman **) Tanggal Dikeluarkan **)
Document No. Record No. **) Date Issued **)
CAST/IV/SM/12-02

*) Diisi oleh Pengguna / Filled by Users

**) Diisi oleh Staff Maintenance/ Filled by Staff Maintenance
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HANDLING EQUIPMENT DAMAGED

Lampiran 3
Appendix 3
DAFTAR RIWAYAT PERBAIKAN TAHUNAN
ANNUAL LIST OF REPAIR HISTORY

No. Rekaman Laporan Selesai Tanggal

Nama Peralatan Deskripsi Kerusakan Mulai Diperbaiki Berapa Kali Perbaikan Dilimbahkan (Ya/Tidak)
No. Perbaikan Diperbaiki Dilimbahkan
Name of Equipment Description of Damage Start Repaired How much time Repairs To be waste (Yes/ No)
Copy of Report Repair No. Repaired Done Date to be Waste

Disiapkan oleh Mengetahui Disetujui oleh

Prepared by, Acknowledge by, Approved by,

Tanggal: Tanggal: Tanggal:

Date Date Date

No. Dokumen No. Rekaman *) Tanggal Dikeluarkan *)

Document No. Record No. *) Date Issued *)
CAST/IV/SM/12-03

*) Diisi oleh Staff Maintenance / Filled by Staff Maintenance

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HANDLING EQUIPMENT DAMAGED

Lampiran 4
Appendix 4

PERMOHONAN PELIMBAHAN PERALATAN

CESSPIT APPLICATION EQUIPMENT

Informasi Peralatan / Information Equipment

Nama / Name
Model
No. Seri / Serial No.
Penggunaan / Use
Tanggal Kalibrasi Terakhir
Date of Last Calibration
Riwayat Perbaikan / Repair history
Tanggal Perbaikan Terakhir
Last Revision Date
Status Perbaikan Terakhir
Finally Repair Status
Alasan Pelimbahan / Reason Cesspool

Metode Pelimbahan / Cesspool Methods

Disiapkan oleh Mengetahui Disetujui oleh

Prepared by Acknowledge by Approved by

Tanggal: Tanggal: Tanggal:

Date Date Date

No. Dokumen No. Rekaman *) Tanggal Dikeluarkan *)

Document No. Record No. *) Date Issued *)
CAST/IV/SM/12-04

*) Diisi oleh Pengguna/ Filled by Users

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HANDLING EQUIPMENT DAMAGED

Lampiran 5
Appendix 5

DAFTAR PERALATAN YANG DILIMBAHKAN

EQUIPMENT LIST TO BE WASTE

No. Rekaman Permohonan Tanggal

Nama Peralatan Alasan Pelimbahan Metode Pelimbahan
No. Pelimbahan Dilimbahkan
Name of Equipment Reason Cesspool Cesspool Method
No. Recording Application cesspool Date to be Waste

Disiapkan oleh Mengetahui Disetujui oleh

Prepared by, Acknowledge by, Approved by,

Tanggal: Tanggal: Tanggal:

Date Date Date

No. Dokumen No. Rekaman *) Tanggal Dikeluarkan *)

Document No. Record No.*) Date Issued *)
CAST/IV/SM/12-05

*) Diisi oleh Staff Asset/ Filled by Staff Asset

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