(Doc. No.: AU-F-YD-7505-01 Rev.

0)

PT. Air & Udara Indonesia

NO. KONTRAK. _____________
Contract No
NO. Laporan O.S & D._______________
O.S & D. REPORT NO
NO. FIELD C.O _______________
LAPORAN KELEBIHAN, KEKURANGAN & KERUSAKAN FIELD C.O. NO.
OVER, SHORT & DAMAGE REPORT TANGGAL. ______________
DATE

NO. PO /PURCHASE ORDERS NO PO DIKELUARKAN UTK / P.O ISSUED TO

ASAL NEGARA TITIK SINNGAH PERKAPALAN PEKERJAAN DI SITE
COUNTRY OF ORIGIN SHIPPING TRANSIT POINT JOB SITE

NO. PO URAIAN BARANG URAIAN KERUSAKAN

PO. ITEM NO DESCRIPTION OF ITEM DESCRPTION OG DAMAGE

Kerusakan Jelas_______________________contoh kongkrit______________di pabrik________pada saat transit______________________penanganan ATA

Damage was obvious concrealed at factory in transit ATA handling
Kerusakan dapat diperbaiki, ya_________________ tidak__________ tdk tahu _________________jaminan MFR efektif, ya_________________tidak____________tidak tahu______
Damage can be repaired yes no don't know MFR's guarantee Affected yes no don't know
Kerusakan dapat diperbaiki dilapangan, ya________ tidak_______MAT'L disyaratkan utk diperbaiki,ya_______________tidak______________________________________________
Damage can be repaired by field yes no MAT'L required for repair yes no
Perkiraan biaya utk perbaikan MAT'L_____________pekerja_____________penggantian MAT'L dibeli oleh lapangan_____________________________kantor pusat_______________
Est. Direct cost for repiar MAT'L labor S replacement MAT'L to be purchased by field home office
Perbaikan dilakukan secepatnya utk mempertahanakan jadwal kontruksi ? Ya_______________tidak______________
Repaired to be made immediately to maintain construction schedule ? Yes
Jika perbaiakan tidak penting haruas diselesaikan tanggal berapa ?__________________________________________
If repair not urgent must be completed by with date ?
Suppliers dihubungi, ya________________________tidak_________nama_________________judul_____________________________________lokasi_________________________
Suplier contacted yes no name title location
Pembawa dihubungi, ya_______________________tidak_________nama_________________judul_____________________________________ lokasi_________________________
Carrier contacted yes no name title location
Jika ya dengan telepon, telex, supplier________________________________________tanggal_______________________________pembawa____________tangga_______________
If yes by phone, telex, supplier date carrier date
Perbaiakan tidak dapat dilanjutkan sampai diijinkan oleh proyek engineer
Do not proceed with repairs until authorized by project engineer
Komentar lain________________________________________________________________________________________________________________________________________
Other comment
Material diatas diterima di boat/Fit no.____________________no. perkapalan________________________________________ no truk ________________________
Above material received on boat/Fit no. Frt. Bill no truck no
Nama kapal pengirim_________________________________tititk pengiriman________________________________________ nama pengirim_______________________________
Name of Shipper shipping point cerrier name
List packing termasuk dalam pengiriman, ya________________tidak____________apakah paket rusak?ya_____________________________tidak ___________________________
Packing List included with shipment? Yes no was packegw brokrn? Yes no

Tanda tngan

Signed

................................................
Catatan tambahan: WAREHOUSEMAN
Additional notes

1. Jika kerusakan jelas pada saat pengiriman. No. Pengangkutan akan dicatat dan ditandatangani oleh pembawa masuakan no. Pengangkut ini dalam laporan

If damage is obvious at time of delivery. The freight bill shall so noted and signed by carrier include this signed freight bill with this report

Dikoordianasikan dengan pembawa dan pemeriksaan material yang rusak secepatnya.

Arrange with carrier and inspection of damage material immediately

2. Jika kerusakan kongkrit beritahu pembawa secepatya setelah dibuka dan melakukan pemeriksaan kerusakan material secepatnya.

If damage concreated notify carrier immediately after unpacking and arrange with carrier an inspection of damage material immediately

3. Untuk no. 1 & 2 di atas laporan pemeriksaan secepatnya dan ditandatangani oleh pembawa dan dilampirkan didalam laporan formulir penanganan GUF

For items 1 and 2 above completed carrier inspection report must be prepared immediately and signed by carriers agent attached to this report GUF handling from

4. Lampiran photo dari material yang rusak di dalam laporan

Attached to this report photographs of damage material