PROJECT :
MERK/TYPE : No. Seri Alat :
Senin Selasa Rabu Kamis Jumat Sabtu Minggu
N0 Item
Baik Rusak Baik Rusak Baik Rusak Baik Rusak Baik Rusak Baik Rusak Baik Rusak
1 Radiator
2 Fuel tank
3 Engine/mesin
4 Hydraulik System
5 Fuel level Indicator
6 Oil Pressure
7 Water Coolant Temperature
8 Ampere/Volt meter
9 RPM
10 Front Lights/lampu depan
11 Hazard Lamp/lampu bahaya
12 Brake Lamp/ lampu rem
13 Backup Alarm/alarm mundur
14 Hydroulic Pump/pompa hydrolik
15 Overhead guard
16 Mast assembly
17 Lift Chain & Roller/Rantai angkat dan roda
18 Lubrication/ pelumasan
19 Fork/ Garpu
20 Wheel Bolts/ baus Roda
21 Tire Condition/Kondisi Roda
22 Horn/Klakson
23 Seat Belt/Sabuk Pengaman
24 Mirror/Spion kaca
25 Fire Extinguisher /Tabung APAR
Catatan :