FORM P2H UNIT LV, BUS DAN MANHAUL

Tanggal : Lokasi Site : Tanggal :

No. Unit : Type Unit : No. Unit :
No. Polisi : KM Awal : No. Polisi :

PEMERIKSAAN BAHAN BAKAR & PELUMAS

No. Keterangan No.
Part ( Peralatan ) Baik Tidak Baik
1 Fuel ( Bahan Bakar) 1
2 Water Accu ( Air Aki) 2
3 Engine Level Oil (Oli Mesin) 3
4 Coolant Fluid ( Air Radioator) 4
5 Fan Belt (Tali Kipas) 5
6 Brake Fluid ( Minyak Rem ) 6
7 Washer (Air Pembersih Kaca) 7
8 Steering Oil ( Oli Kemudi) 8
9 Hydraulic Oil Pump ( Oli Hidrolik) 9
10 Clutch Fluid ( Minyak Kopling ) 10
PEMERIKSAAN KOMPONEN
No. Keterangan No.
Part ( Peralatan ) Baik Tidak Baik
1 Head Light ( Lampu Depan) 1
2 Tail Light ( Lampu Belakang ) 2
3 Turn Light Signal ( Lampu Signal) 3
4 Hazard Light ( Lampu Bahaya ) 4
5 Fog Light ( Lampu Kabut ) 5
6 Brake Light ( Lampu Rem) 6
7 Back Alarm ( Alaram Mundur) 7
8 Back Light ( Lampu Mundur) 8
9 Rotary Light ( Lampu Rotary) 9
10 Body Car ( Bodi Mobil ) 10
11 Buggy Whip ( Bendera Tambang ) 11
12 Tire ( Ban ) 12
13 Tire Nuts ( Baut Roda ) 13
14 Tire Spare ( Ban Serep ) 14
15 Tire Air Pressure ( Tekanan udara Ban) 15
16 Spring ( Suspensi/Per) 16
17 Track Road 17
 PEMERIKSAAN DALAM KABIN
No. DI INSPEKSI No.
Part ( Peralatan ) Baik Tidak Baik
1 Seat Belt ( Sabuk Pengaman ) 1
2 Fire Extingusher ( Pemadam Api Ringan) 2
3 First Aid Box ( Kotak P3K ) 3
4 Triangle ( Segitiga Pengaman ) 4
5 Jack & Tire Wrech ( Dongkrak & Kunci Roda) 5
6 Steering Whell ( Roda Kemudi) 6
(............................................)
7 Mirror ( Kaca Spion ) Driver / Operator 7
8 Horn ( Klakson) 8
9 Wiper ( Pembersih Kaca ) 9
10 Speedometer ( Pengukur Kecepatan ) 10
11 Odometer ( Pengukur Jarak Tempuh ) 11
12 Tachometer ( Pengukur RPM ) 12
13 Clutch ( Kopling ) 13
14 Service Brake ( Rem Kaki ) 14
15 Hand Brake ( Rem Tangan ) 15
16 Dif. Look Inter Axxel ( Penguncian Antar Gardan ) 16
17 Dif. Look Inter Whell ( Penguncian Antar Roda ) 17
18 PTO (Power Take Off) (............................................) 18
19 Transfer Gear ( Fungsi Double Gardan) Foreman / Supervisior 19
20 Remote Free Whell (Tombol Gardan Depan ) 20
21 Vehicle Number Sign ( STNK) 21
22 Periodic Inspectsion ( Stiker Layak Uji / Permit) 22
 FORM P2H UNIT LV, BUS DAN MANHAUL

ggal : Lokasi Site :

Unit : Type Unit :
Polisi : KM Awal :

PEMERIKSAAN BAHAN BAKAR & PELUMAS

Keterangan
Part ( Peralatan ) Baik Tidak Baik
Fuel ( Bahan Bakar)
Water Accu ( Air Aki)
Engine Level Oil (Oli Mesin)
Coolant Fluid ( Air Radioator)
Fan Belt (Tali Kipas)
Brake Fluid ( Minyak Rem )
Washer (Air Pembersih Kaca)
Steering Oil ( Oli Kemudi)
Hydraulic Oil Pump ( Oli Hidrolik)
Clutch Fluid ( Minyak Kopling )
PEMERIKSAAN KOMPONEN
Keterangan
Part ( Peralatan ) Baik Tidak Baik
Head Light ( Lampu Depan)
Tail Light ( Lampu Belakang )
Turn Light Signal ( Lampu Signal)
Hazard Light ( Lampu Bahaya )
Fog Light ( Lampu Kabut )
Brake Light ( Lampu Rem)
Back Alarm ( Alaram Mundur)
Back Light ( Lampu Mundur)
Rotary Light ( Lampu Rotary)
Body Car ( Bodi Mobil )
Buggy Whip ( Bendera Tambang )
Tire ( Ban )
Tire Nuts ( Baut Roda )
Tire Spare ( Ban Serep )
Tire Air Pressure ( Tekanan udara Ban)
Spring ( Suspensi/Per)
Track Road
 PEMERIKSAAN DALAM KABIN
DI INSPEKSI
Part ( Peralatan ) Baik Tidak Baik
Seat Belt ( Sabuk Pengaman )
Fire Extingusher ( Pemadam Api Ringan)
First Aid Box ( Kotak P3K )
Triangle ( Segitiga Pengaman )
Jack & Tire Wrech ( Dongkrak & Kunci Roda)
Steering Whell ( Roda Kemudi)
(............................................)
Mirror ( Kaca Spion ) Driver / Operator
Horn ( Klakson)
Wiper ( Pembersih Kaca )
Speedometer ( Pengukur Kecepatan )
Odometer ( Pengukur Jarak Tempuh )
Tachometer ( Pengukur RPM )
Clutch ( Kopling )
Service Brake ( Rem Kaki )
Hand Brake ( Rem Tangan )
Dif. Look Inter Axxel ( Penguncian Antar Gardan )
Dif. Look Inter Whell ( Penguncian Antar Roda )
PTO (Power Take Off) (............................................)
Transfer Gear ( Fungsi Double Gardan) Foreman / Supervisior
Remote Free Whell (Tombol Gardan Depan )
Vehicle Number Sign ( STNK)
Periodic Inspectsion ( Stiker Layak Uji / Permit)