Notification & Work Order Sheet

Notification No: Subject of Activity

8290003190 BI_WEEKLY SAFETY & MECHANICAL INSPECTION

Week Plan : 35 Equipment No. : 82EX0185 - HITACHI, ZX200-SG

Planned Order : Equipment Description : 82EX0185 - HITACHI, ZX200-SG
Unplanned Order :
Asset Location :
Dayshift :
Night Shift : Date Scheduling : 31-Aug-22 Est. Work Duration : 3.00 Hrs

Work Order No: Start Down Date : Time Start :

Finish Down Date : Time Finish :
Hourmeter / Kilometer :
By Calender Time :

Labor Requirement
No Name Position No Name Position

Job Description Detail

Job Status : Done / Completed : Rescheduling : Next Day : Delayed : Waiting Parts :
Next Week : Waiting Tools :
Next Month : Lack Of Manpower :
Specify Reason : Operational still used :

Inspected by Reviewed by Acknowledged by

Mechanic / Technician Supervisor Superintendent / Manager

 NOTIFICATION & WORKORDER SHEET
QUALITY ASSURANCE CHECKLIST

Notification No.
8290003190 Schedule Start Date :
Work Order No.
Week No. :
Subject :
Equipment No : BI_WEEKLY SAFETY & MECHANICAL INSPECTION
82EX0185 - HITACHI, ZX200-SG

Catatan : Sebagai penjamin kualitasterhadap hasil pekerjaan pada unit / komponent yang tertera dala Jon Sheet Notification Order
yang telah di tanda tangani oleh Supervisor, Foreman pada form Notif ini, dan Superintendent berkewajiban mereview dan
bertangung jawab sepenuhnya terhadap isi dari job sheet form Notification Order tersebut dengan juga memastikan
semua item checklist pada form Notification Order dibawah ini telah di konfirmasi seluruhnya.

Quality Assurance Checklist Item :

1. Pastikan pekerjaan yang tertera pada Notification Order form (tindakkan perbaikan dan perawatan
system/unit) sudah terselesaikan dan system atau unit telah kembali pada speksifikasi asli
maupun kembali berfungsi dengan normal
Ensure job noted dalam Notification Order form (system / unit maintenance and repair action) have
been resolved and the system or unit has returned back to original specification or operation.

2 Pastikan semua item rekomendasi (jika ada) pada activity task dalam form sudah terselesaikan
Ensure all recommendation item (if any) in the activity task of form has been completed

3 Pastikan kualitas & penyelesaian pekerjaan sesuai dengan prosedur kerja yang ada untuk menghindari atau
meminimalisir resiko terjadinya rework atau redo job
Ensure the quality and completion of work are in accordance with the exiting work procedures to avoid and
minimize the risk of job rework or redo.

4 Pastikan semua doument pendukung sudah diselesaikan dan terlampir besama Notification Order jobsheet
form
(Contoh : jika ada Service Package, Inspection Check List, Test Perfoma)
Esnure all supporting documents have been completed and attached with Notification Order form
(Example : Service Package, Inspection Check List, Perfomance Test)

5 Pastikan unit yang telah di selesaikan tindakan perbaikan ataupun perawatannya sudah dalam posisi &
kondisi aman untuk kembali beroperasi
Ensure the unit which has had its repair or maintenance completed to handed back in a safe position and
condition to get back for operation

Superintendent Comment

Superintendent Approval

Insert your Sign

Superintendent Date Signature

Once printed this document becomes uncontrolled. Refer to ISO certified beyond360 Management
Doc No. IMU-CORP-AM-FO-004 System for controlled copy Page 2 of 6
REGULAR SAFETY MECHANICAL INSPECTION
Excavator
No OK Not N/A
Task Description / Deskripsi Tugas Remarks / Comments
OK
A. PRE-START SAFETY ACTIVITIES

1 Catat hours meter service (tidak termasuk bilangan desimal), down time/ delay
Record Hour Meter Service (Non decimal point), Down Time/ Delay
2 Cuci unit sebersih mungkin
Washing Unit Properly
3 Parkir unit posisi service pada permukaan rata & pasang rem parkir
Park Unit to Service Position on firm & Level Ground & Apply Parking Brake
4 Pastikan semua handel kontrol pada posisi netral
Ensure Control Handles on Neutral Position
5 Matikan mesin dan switch baterai utama pada posisi OFF
Turned Off Engine & Main Battery Switch on OFF Position
6 Pasang 'master lock' dan kartu isolasi oleh pengawas
Apply Master Lock & Tie 'Isolation' Tag by Supervisor
7 Pasang tanda bahaya pribadi dan kartu peringatan service
Tie 'Personal Danger' tag & 'Out of Service' tag
8 Dilarang yg tidak berkepentingan di sekitar unit saat service
All Unauthorized Persons should be Kept from the Machine when Maintenance being Performed
9 Gunakan APD yang tepat pada saat service
Used Personal Safety Gear when servicing
10 Pagar
Hand Rails
11 Tangga & Tempat Pijakan
Ladders & Steps
12 Sistem Pemadam Otomatis-Bila Ada
Fire Suppression System-If Equipped
14 Tabung Pemadam Kebakaran
Fire Extinguisher
15
ROPS / FOPS

16 Kondisi Sabuk Pengaman

Safety Belt Condition
17 Lampu Rotari
Rotary Light / Strobe Light
18 Tutup Pengaman
Safety Guard - Fan, Belt, Driveshaft, Radiator etc.
19 Tanda/Label Peringatan Tersedia & Jelas
All Warning Tags/Safety Labels Fitted & Clear
20 Kelengkapan Sistem Hidrolik/Angin
Hydraulic/Pneumatic Attachments

B. ENGINE

1 Periksa kebocoran air

Check for water leaks
2 Periksa kebocoran oli sekitar engine
Check for oil leaks around engine
3 Periksa kebocoran sistem fuel
Check for fuel system leaks
4 Periksa kondisi hose dan clamp
Check for conditions of hoses and clamps, replace when required)
5 Periksa ketegangan kondisi V-belt
Check tension and condtion of v-belt
6 Periksa core radiator
Inspect radiator core
7 Periksa bearing kipas dan pulley yang longgar
(Inspect fan and pulley bearings for looseness)
8 Periksa kekencangan baut kedudukan mesin
(Check engine mount bolts are tight)
9 Periksa sambungan sistem knalpot yang bocor
(Inspect exhaust system joints for leaks)

C. HYDRAULIC, TRAVEL AND SWING SYSTEM

1
Periksa mounting komponen (pump, motors, clamps…dll ) (Check mounting pump, motors, clamps…etc)

2 Periksa kondisi rod & silinder

(Check hyd rods & cylinder conditions)
3 Periksa kondisi semua hidrolik hose
(Inpect condition of all hyd hoses, replace when required)
4 Periksa kebocoran hIdrolik sistem
(Check any leaks for hyd system)
5 Periksa gearbox dan motor swing mounting
(Check mounting of gear and oil motor for swing gear)
6 Periksa mounting bolt slew ring
Check and tighten swing rings mounting screw swing rings)
7 Periksa kebocoran pada travel gears
Check for leaks for travel gears)
8 Periksa baut mounting gears, sprocket and oil motor
(Check mounting screws of gears, sprocket and oil motors)

D. ELECTRICAL SYSTEM

1 Periksa kunci kontak bekerja dengan baik

(Check Key switch working propperly)

Once printed this document becomes uncontrolled. Refer to ISO certified beyond 360
Management System for controlled copy Page 4 of 6
REGULAR SAFETY MECHANICAL INSPECTION
Excavator
No OK Not N/A
Task Description / Deskripsi Tugas Remarks / Comments
OK
2 Periksa isolation switch berfungsi
(Check isolation switch function)
3 Periksa semua gauge & control panel indicator berfungsi
Check all gauges & control panel indicators for normal working)
4 Periksa semua tombol berfungsi
(Check all application switches)
5 Periksa Warning alarm/Buzzer berfungsi
(Check warning alarm/buzzer)
6 Periksa kondisi sekering & pemutus arus
(Check condition of fuses & circuit breakers)
7 Periksa semua lampu penerangan bekerja dengan baik
(Check all lightings working properly)
8 Periksa lampu rotary berfungsi
(Check rotary lamp function)
9 Periksa sistem charging bekerja dengan baik
(Check charging system for normal operation)
10 Periksa sistem starting bekerja dengan baik
(Check starting system for normal operation)
11 Periksa alarm & klakson bekerja dengan baik
(Check alarm & horn working properly)
12 Periksa Radio komunikasi berfungsi dengan baik(
Check 2-way radio communication)
13 Periksa system pendingin bekerja dengan normal
(Check air conditioning system for normal operation)
14 Periksa pembersih kaca berfungsi dengan baik
(Check washer wiper function)

E. STRUCTURE & ATTACHEMENT

1 Periksa dan kencangkan baut track pad

Check and tighten mounting screws of track pads
2 Periksa dan kencangkan baut track pad
Check and tighten mounting screws of track pads
3 Periksa kebocoran pada idler, carrier and track roller
Check idler, carrier and track rollers for any leaks
4 Periksa baut under carriage yg kendor
Check any loose of bolts for undercarriage compartment
5 Periksa keretakan pada bucket
Check bucket for cracks
6 Periksa keretakan pada boom frame
Check boom frame for cracks
7 Periksa keretakan semua bagian frame
Check all parts for cracks
8 Periksa keausan pin dan bush pada attachment dengan menggerakanya
Check pin and bush movement on the attachment for wear
9 Periksa kekencangan baut counterweight dan tangki
Check tighten mounting screws of counterweight and tank
10 Periksa grease line dan nozzlenya
Check all grease line and grease nozzle work properly advise to service

F. OTHER

1 Periksa jendela kabin dari kerusakan

Check The Window Of cab For Damage
2 Periksa pintu kabin & pengunci pintu berfungsi dgn baik
Check The Cab Door & Door Lock work Properly
3 Periksa cermin (spion) luar & dalam dari kerusakan
Check The Outside & Inside Mirrors For Damage
4 Periksa kerja hidrolik cab tilting
Check The Operation Of The Hydraulic Cab Tilting Device
5 Periksa komponent hidrolik cab tilting (kebocoran/kerusakan pada hidrolik silinder, hose, sambungan-sambungan)
Check Hyd Cab Tilting Device (Check hyd Cyl, Hoses & Connections for Leaks & Damage)
6 Periksa cab elevation sistem (periksa kerja dari acoustic warning signal, operating elements(valve,display, dsb), periksa safety chain ada &
berfungsi dgn baik)
7 Periksa kursi operator berfungsi dgn benar
Check The Driver's Seat Works Properly
8 Lumasi semua fitting grease pada unit
Lubricate all Grease Fitting Points
9 Pastikan peralatan darurat (Kotak P3K & Emergency Hammer) tersedia
Make Sure That Emergency Devices (First Aid Box & Emergency Hammer) are available
10 Pastikan safety sign ada di tempatnya, terbaca & tidak rusak
Check Safety Sign to Ensure They Are Complete, Legible & Undamaged
11 Periksa kursi operator berfungsi dgn benar
Check The Driver's Seat Works Properly
12 Lumasi semua fitting grease pada unit
Lubricate all Grease Fitting Points

N. BEFORE UNIT SEND TO OPERATION

1 Pastikan tutup oli sudah terpasang benar & tidak ada kebocoran
Ensure Drain Plug Correctly Fitted & No Leakages
2 Pastikan semua ketinggian oli komponen sudah benar
Ensure all Compartments Oil Level are Correct
3 Bersihkan kotoran oli dan kain lap yang tersisa saat service
Clean Waste oil, Racks & other Rubbish from unit after service

Once printed this document becomes uncontrolled. Refer to ISO certified beyond 360
Management System for controlled copy Page 5 of 6
REGULAR SAFETY MECHANICAL INSPECTION
Excavator
No OK Not N/A
Task Description / Deskripsi Tugas Remarks / Comments
OK
4 Bunyikan klakson panjang 1 (satu) kali sebelum menghidupkan mesin
Sound Horn (1x) before Starting Engine
5 Periksa semua personil aman sebelum unit uji jalan
Check all Personals on Safe Condition before Test Running

G. ADDITIONAL CHECKS

Inspected by Acknowledged by,

Mechanic / Electrician Foreman / Supervisor

Once printed this document becomes uncontrolled. Refer to ISO certified beyond 360
Management System for controlled copy Page 6 of 6
 Backlog Record

Equipment No. : 82EX0185 - HITACHI, ZX200-SG Notif No. : 8290003190 WO No. : Date :

Priority
No Subject Fault Defect Found Action Need To Do Components Part No Part Description Qty Remarks
P1 P2 P3

10

Legends :
P1 :Immediately Action
P2 :Next Week Plan (including preparation tools, parts & PRTS..etc) Inspection by Checked by Aknowledge by
P3 :Next PM_Service Including

Mechanic / Electrician Supervisor Superintendent