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VEHICLE/EQUIPMENT INSPECTION POST OF FATALITY INCIDENT PT.

AB
PT ………..
Last Updated:

Summary Report

Inspected By All Items Follows Brake


Equip. No Of Commissioning Expired Result
No (Delaer or Reg. KM/HM Date Comm. Checklist Measurement Remarks
Type Equip. Date Date (Fail or Pass)
Cont.) (YES or NOT) (YES OR NO)

Date:
INSTRUKSI PENTING:
Untuk kendaraan berisiko tinggi seperti Mixer Truck, Fuel Truck, Lub Truck, BUS, Omni Bus, dll
Dibutuhkan pemeriksaan/pengukuran kondisi sistim pengereman.
Name & B/N
PJO PT………………

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