NOTIFICATION & WORK ORDER SHEET

Notification No. Subject / Description Of Fault / Broken

8290002752 BI-WEEKLY SAFETY & MECHANICAL INSPECTION

Week No. : 21 Equipment No. : 82PM0222 - IVECO, AD380T38H, 6x4

Planned order : Equipment Description. : 82PM0222 - IVECO, AD380T38H, 6x4

Unplanned Order : Location : Interport Business Park Kariangau

Dayshift : Est. Work Duration : 2.0 hrs Actual Hrs : 0.0

Night Shift : Schedule Start Date : 29-May-2022

Work Order No.

Malfunction Start Date : Time In :

Malfunction End Date : Time Out :

Hour Meter : hrs Total Hrs : 0.0

REQUIREMENT LABOR
BADGE NO NAME POSITION BADGE NO NAME POSITION

MATERIAL / SERVICE PART

MPN Manufacture No Part Description Qty Unit Issue Voucher No Reservation No.

Action / Detail of Job / Operation

Notif No. 8290002752 WO :

Performed By Reviewed By Approved By

Insert your Sign Insert your Sign Insert your Sign

Mechanic / Electric Foreman / Supervisor Maint. Superintendent

Once printed this document becomes uncontrolled. Refer to ISO certified beyond360 Management Page 1 of 8
Doc No. IMU-CORP-AM-FO-004 System for controlled copy
 NOTIFICATION & WORKORDER SHEET
QUALITY ANSSURANCE CHECKLIST

Notification No.
8290002752 Schedule Start Date :
Work Order No.
Week No. : 21
Subject :
Equipment No :
BI-WEEKLY SAFETY & MECHANICAL INSPECTION
82PM0222 - IVECO, AD380T38H, 6x4

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 Page 2 of 8
Doc No. IMU-CORP-AM-FO-004 System for controlled copy
 Backlog Record

Equipment No. : Notif No. : 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

Once printed this document becomes uncontrolled. Refer to ISO certified beyond360 Management Page 3 of 8
System for controlled copy
REGULAR SAFETY MECHANICAL INSPECTION
Fire Truck Module
No OK Not N/A
Task Description / Deskripsi Tugas Remarks / Comments
OK
A. PRE-START SAFETY ACTIVITIES

1 Catat Hours Meter (tidak termasuk bilangan desimal), Down time/ Delay
Record Hour Meter (Non decimal point), Down Time/ Delay
2 Cuci Unit Sebersih Mungkin
Washing Unit Properly
3 Parkir Unit pada Permukaan Rata dan Pasang Rem Parkir
Park Unit 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 yang Tidak Berkepentingan Berada di Sekitar Unit
All Unauthorized Persons should be Kept from the Machine when Maintenance being Performed
9 Gunakan APD yang tepat
Used Personal Safety Gear
10 Pagar
Hand Rails
11 Tangga & Tempat Pijakan
Ladders & Steps
12 Sistem Pemadam Otomatis-Bila Ada
Fire Suppression System-If Equipped
13 Spion
Mirror
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 dan Jelas
All Warning Tags/Safety Labels Fitted & Clear
20 Kelengkapan Sistem Hidrolik/Angin
Hydraulic/Pneumatic Attachments

B. ENGINE

1 Kebocoran Oli
Oil Leaks
2 Kebocoran Bahan Bakar
Fuel Leaks
3 Kebocoran Air Radiator
Water Leaks
4 Kebocoran Udara
Air Leaks
5 Kondisi & Tegangan Belt
Belt Tension & Condition
6 Sambungan-sambungan & Dudukan
Linkages & Mountings
7 Semua Baut Pengikat
All Retaining Bolts
8 Kondisi Semua Hose Bahan Bakar dan Udara dari Kerusakan
All Hoses Fuel & Air System For Condition/Chaffing
9 Kondisi Hose Radiator, Kekencangan Klam
Radiator Hoses Condition, Clamps For Tightness
10 Indikator Level Air Radiator
Cooling System Level Indicator
11 Kebocoran Sistem Pemasukan Udara
Induction System For Leaks, Clamps For Tightness
12 Kebocoran Gas Buang
Exhaust System For Leaks
13 Fungsi Darurat Mematikan Mesin
Engine Stop Operation
14 Kondisi Sirip Inter Cooler & Sambungan
Inter Cooler Core & Connection
15 Kompressor Udara & Dudukan
Air Compressor & Mounting

C. POWER TRAIN

1 Kebocoran Oli Transmission, Differential, Planetary Hub

Oil Leaks from Transmission, Differential, Planetary Hub
2 Kebocoran Sistem Udara (Transmission Manual)
Air System Leaks (Manual Transmission)
3 Penyetelan Tuas Kontrol
Control Lever Adjustment
4 Sambungan, Dudukan & Baut Pengikatnya
Linkages, Mountings & Bolts
5 Shaft Penggerak & Sambungan Universal
Drive Line & U-Joints
6 Penyimpangan Bearing Roda Depan
Front Wheel Bearings Deflection

Once printed this document becomes uncontrolled. Refer to ISO certified beyond 360
Management System for controlled copy
Page 4 of 8
REGULAR SAFETY MECHANICAL INSPECTION
Fire Truck Module
No OK Not N/A
Task Description / Deskripsi Tugas Remarks / Comments
OK
7 PTO & Dudukannya
PTO & Mounting

D. SUSPENSION & FRAME

1 Kondisi Spring Suspension

Spring Suspension Condition
2 Karet Suspensi
Rubber Suspension
3 Pin & Bushing
Pins & Bushings
4 Baut U
U-Bolts
5 Dudukan & Braketnya
Mountings & Brackets
6 Peredam Kejut
Shock Absorbers
7 V-Stay & Dudukannya
V-Stays & Mountings
8 Reaction Rod & Dudukannya
Reaction Rods & Mounting
9 Anti Roll Bar & Shackle nya
Anti Roll Bar & Shackles
10 Cross Stay
Cross Stay
11 Keretakan Pada Rangka Utama
Main Frame For Crack
12 Kelurusan Axle
Axle Alignment

E. CABIN

1 Kaca Depan & Jendela

Windscreen & Window glass
2 Pelapis Karet
Rubber Seal
3 Pintu, Pegangan Tangan, Pengunci & Engsel
Door, Lock, Handle & Hinges
4 Dudukan & Suspensi
Mounting & Suspension

F. ELECTRICAL INSPECTION

1 Kunci Kontak
Key Switch
2 Tombol Test Indikator
Indicator Test Switch
3 Pengukur Tekanan Angin
Air System Pressure Gauge
4 Pengukur Suhu Kerja Mesin
Engine Coolant Temperature Gauge
5 Pengukur Putaran Mesin
Tachometer
6 Voltmeter
Pengukur Tegangan
7 Lampu Peringatan
Warning Lamp
8 Alarm Peringatan
Warning Buzzer/Alarm
9 Tombol-tombol untuk Lampu
Light Switches
10 Semua Lampu Indikator
All Alert Indicator Lights
11 Pengukur Jam Kerja Mesin
SMU / HMU
12 Sekring & Pemutus Arus
Fuses & Circuit Breaker
13 Tuas Kontrol Lampu Sein
Directional Turn Signal & Hazard Flasher Control
14 Tuas Kontrol Lampu Dekat/Jauh
High/Low Beam Control
15 Lampu Kabin
Cabin Lamp
16 Lampu Dashboard
Dash Panel Light
17 Lampu Sein Kiri / Kanan
Turn Signal Lamp (LH / RH )
18 Lampu Kerja Depan
Front Floodlights
19 Lampu Kerja Samping
Side Floodlights
20 Lampu Kerja Belakang
Rear Floodlights
21 Lampu Jauh
High Beam Lamp
22 Lampu Mundur
Reverse Lamp
23 Lampu Jalan
Road Lamp

Once printed this document becomes uncontrolled. Refer to ISO certified beyond 360
Management System for controlled copy
Page 5 of 8
REGULAR SAFETY MECHANICAL INSPECTION
Fire Truck Module
No OK Not N/A
Task Description / Deskripsi Tugas Remarks / Comments
OK
24 Lampu Rotari
Rotary Lamp/Flash Light/ Strobe Light
25 Lampu asesoris
Accessories Lamp
26 Tegangan Keluar Alternator
Alternator Output Voltage
27 Kondisi Alternator, Belt serta Penyetelnya
Alternator, Belt Condition & Adjuster
28 Pemutus Hubungan Baterai
Battery Disconnect Switch
29 Kondisi & Beban Kerja Baterai
Battery Condition & Load
30 Level Air Baterai
Electrolyte Level
31 Kabel & Terminal Baterai
Battery Cable and Terminal
32 Kabel Massa
Ground Cable
33 Kabel Harness
Cable Harness
34 Kerja/Kondisi Motor Starter
Starter Motor Operation/Condition
35 fungsi Solenoid
Solenoid function
36 Kabel & Terminal
Cables & Terminals

G. STEERING

1 Kebocoran Oli Steering

Steering Oil Leaks
2 Selang, Pipa & Pengikatnya
Hoses, Pipes & Clamps
3 Sambungan, Dudukan & Baut Pengikatnya
Linkages, Mountings & Bolts
4 Roda Kemudi & Steering Column
Steering Wheel & Steering Column
5 Karet Pelindung Ball Joint
Gaiter For Ball Joints
6 Stering Knuckle & Sambungannya
Steering Knuckle Journaling
7 King Pin & Bearing
King Pins & Bearings

H. BRAKE

1 Tekanan Udara & Penunjuk Udara

Air Pressure & Gauge
2 Pengatur Tekanan Udara
Air Pressure Regulator
3 Kebocoran Sistem Udara
Air System Leaks
4 Tangki Udara & Dudukannya
Air Tanks & Mountings
5 Selang, Pipa & Pengikatnya
Hoses, Pipes & Clamps
6 Kanvas Rem Depan & Penyetelnya
Front Brake Lining Pad & Adjuster
7 Kanvas Rem Belakang & Penyetelnya
Rear Brake Lining Pad & Adjuster
8 Brake Chamber & Dudukannya
Brake Chambers & Mountings
9 Pengering Udara
Air Dryer

I. ACCESSORIES

1 Radio Komunikasi Dua Arah

2-Way Radio Communication
2 Klakson
Horn
3 Alarm Mundur
Reverse Alarm
4 Unjuk Kerja & Kontrol Pendingin Udara
Air Conditioning Operation & Control
5 Kondisi Kompresor Pendingin Udara
A/C Compressor Condition
6 Kondisi Belt & Penyetelnya
A/C Compressor Belt Condition & Adjuster
7 Pengering Udara
Air Dryer
8 Periksa dan Bersihkan Kondensor
Condensor, Check and Service
9 Periksa & Bersihkan Evaporator
Evaporator, Check And Service
10 Tekanan Kerja Refrigerant
Refrigerant Charging Pressure
11 Pipa / Jalur Pendingin Udara
A/C Line/Piping

Once printed this document becomes uncontrolled. Refer to ISO certified beyond 360
Management System for controlled copy
Page 6 of 8
REGULAR SAFETY MECHANICAL INSPECTION
Fire Truck Module
No OK Not N/A
Task Description / Deskripsi Tugas Remarks / Comments
OK
12 Kipas Blower
Fan Blower
13 Fungsi Kerja Kipas Kaca
Washer Wipers Function
14 Karet / Sirip Kipas Kaca
Wiper Blade

J. OPERATIONAL TEST (Kimper/Simper Required-Pelaksana Harus Memiliki Kimper/Simper)

1 Hidupkan Mesin-Periksa Suara yang Tidak Biasa

Engine Running (Check For Unusual Noise)
2 Perpindahan Gigi Transmissi
Transmission Shifting
3 Rem Parkir
Parking Brake
4 Sistem Kemudi
Steering System
5 Sistem Hidrolik/Angin
Hydraulic/Pneumatic System

FIRE TRUCK MODULE

K. MODULE ON FIRE TRUCK

1
Oil Compressor Level

2
Oil Compressor Leaks

3
Compressor V-Belt

4
Compressor Coolant Leak

5
Compressor Coolant Level

6
Water Leaking

7
Coupling Rubber for Motor Drive Connection

12
Cables and Wiring

15
Lubricator Oil Level

16
Hoses and Dispensing Nozzle

17
Hose Reel for Fire Hose Spray

18
Motor Canon Function

19
Remote & Motor Rotating / Swing Function

20
Step Ladder

21
Warning Signs

22
Control Panel of Service Module

23
Switch and solenoid

24
Plug

25
Hydraulic Motor

26
Mounting Rubber Shaft to Gear Box Condition

27
Fire Extinguisher

L. OPERATIONAL TEST (Kimper/Simper Required-Pelaksana Harus Memiliki Kimper/Simper)

1 Hidupkan Mesin-Periksa Suara yang Tidak Biasa

Engine Running (Check For Unusual Noise)
2 Perpindahan Gigi Transmissi
Transmission Shifting
3 Rem Parkir
Parking Brake
4 Sistem Kemudi
Steering System
5 Sistem Hidrolik/Angin
Hydraulic/Pneumatic System

M. ADDITIONAL CHECKS

Once printed this document becomes uncontrolled. Refer to ISO certified beyond 360
Management System for controlled copy
Page 7 of 8
REGULAR SAFETY MECHANICAL INSPECTION
Fire Truck Module
No OK Not N/A
Task Description / Deskripsi Tugas Remarks / Comments
OK
5

Inspected by Acknowledged by

Insert your Sign Insert your Sign

Mechanic Foreman / Supervisor

Once printed this document becomes uncontrolled. Refer to ISO certified beyond 360
Management System for controlled copy
Page 8 of 8