REKAP PEMELIHARAAN SARANA, PRASARANA, INSTALASI DAN PERALATAN

Perusahaan : PT Multi Ardecon 1 HM/KM Actual : 90,408 6

Periode Pemeliharaan : 27 Februari 2022 - 28 Februari 2023 2 Interval Servis : 5,000 7
Kode Unit : MA-001 3 Running / day : 85 8
Tipe Unit : Kijang Innova 2.4 G M/T 4 Interval / day : 59 9
S/N Unit : MHFJB8EM2K1059979 5

Pemeliharaan Terjadwal
Pemeliharaan Tidak Terjadwal Selesih Rencana
Rencana Pemeliharaan Realisasi Pemeliharaan
No. Keterangan Status
Tanggal HM / KM Type Servis Tanggal HM / KM Type Servis Tanggal HM / KM %

Ganti Oli Mesin, Ganti Filter Oli, Ganti Filter AC, Ganti Filter Solar, Ganti
1 1-Feb-22 60000 20000 14-Feb-22 60008 20000 ------------------------------------------- 0% Minyak Rem, Ganti Minyak Kopling, Ganti Filter Udara, Ganti Air Selesai
Radiator, Ganti Oli Steering

3 1-Apr-22 65000 5000 22-Apr-22 65211 5000 ------------------------------------------- 4% Ganti Oli Mesin, Ganti Filter Oli, Ganti Filter AC, Ganti Filter Solar Selesai

4 1-Jun-22 70000 10000 11-Jun-22 70020 10000 ------------------------------------------- 0% Ganti Oli Mesin, Ganti Filter Oli, Ganti Filter AC Selesai

5 1-Aug-22 75000 15000 15-Aug-22 75122 15000 ------------------------------------------- 2% Ganti Oli Mesin, Ganti Filter Oli, Ganti Filter AC, Ganti Filter Solar Selesai

Ganti Oli Mesin, Ganti Filter Oli, Ganti Filter AC, Ganti Filter Solar, Ganti
6 1-Oct-22 80000 20000 21-Oct-22 80102 20000 ------------------------------------------- 2% Minyak Rem, Ganti Minyak Kopling, Ganti Filter Udara, Ganti Air Selesai
Radiator, Ganti Oli Steering

7 1-Dec-22 85000 5000 22-Dec-22 85026 5000 ------------------------------------------- 1% Ganti Oli Mesin, Ganti Filter Oli, Ganti Filter AC, Ganti Filter Solar Selesai

8 1-Jan-23 90000 10000 29-Jan-22 90088 10000 ------------------------------------------- 2% Ganti Oli Mesin, Ganti Filter Oli, Ganti Filter AC Selesai

9 ----------------------------------------------------------------------------------------------------- 1-Feb-23 90155 0% Ganti Ban Depan R/L dan Ban Belakang R/L (4pcs) Selesai
Catatan :
Note :
1. Service terakhir sampai ke waktu Commisioning tidak boleh melebihi 1 X interval service.
2. Jika terjadi selisih Rencana + 20% maka harus membuat PICA.

Tanjung, 28 Februari 2023

Dibuat Oleh, Di Review Oleh, Disetujui Oleh, Diketahui Oleh,

…................... …....................... …....................... ….......................

SHE PT. Multi Ardecon PJO PT. Multi Ardecon SHE KO PT. Putra Perkasa Abadi Keselamatan Operasi PT Adaro Indonesia
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F-AI-OHS-08-090 Rev.01
 REKAP PEMELIHARAAN SARANA, PRASARANA, INSTALASI DAN PERALATAN
Perusahaan : PT Rante Mutiara Insani 1 HM/KM Actual : 9,168 6
Periode Pemeliharaan : 28 DESEMBER 2021 - 14 DESEMBER 2022 2 Interval Servis : 500 7
Kode Unit : R-467 3 Running / day :8 8
Tipe Unit : Dump Truck Hino FM260JD 4 Interval / day : 63 9
S/N Unit : MJEFM8JN1HJE 23684 5

Pemeliharaan Terjadwal
Pemeliharaan Tidak Terjadwal Selesih Rencana
Rencana Pemeliharaan Realisasi Pemeliharaan
No. Keterangan Status
Tanggal HM / KM Type Servis Tanggal HM / KM Type Servis Tanggal HM / KM %

1 26-Dec-21 8500 500 28-Dec-21 8520 1000 ------------------------------------------- 4% Ganti Engine Oil Filter,Fuel Filter,Racor Filter,Engine Oil,Transmision Oil & Selesai
Diffrential Oil
2 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
3 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
4 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
5 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
6 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
7 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
8 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
9 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
10 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
11 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
12 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
13 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
14 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
15 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
16 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
17 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
18 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
19 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
20 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
21 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
22 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
23 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai
24 -------------------------------------------------------------- ---------------------------------------------------------- 0% Selesai

Ganti Engine Oil Filter,Fuel Filter,Racor Filter,Engine Oil,Transmision Oil &

25 1-Mar-22 9000 1000 9-Mar-22 9012 1000 ------------------------------------------- 2% Selesai
Diffrential Oil

26 -------------------------------------------------------------- -------------------------------------------------------------- 0%
27 -------------------------------------------------------------- -------------------------------------------------------------- 0%
28 -------------------------------------------------------------- -------------------------------------------------------------- 0%
29 -------------------------------------------------------------- -------------------------------------------------------------- 0%
30 -------------------------------------------------------------- -------------------------------------------------------------- 0%
31 -------------------------------------------------------------- -------------------------------------------------------------- 0%
32 -------------------------------------------------------------- -------------------------------------------------------------- 0%
33 -------------------------------------------------------------- -------------------------------------------------------------- 0%
34 -------------------------------------------------------------- -------------------------------------------------------------- 0%
35 -------------------------------------------------------------- -------------------------------------------------------------- 0%
36 -------------------------------------------------------------- -------------------------------------------------------------- 0%
37 -------------------------------------------------------------- -------------------------------------------------------------- 0%
38 -------------------------------------------------------------- -------------------------------------------------------------- 0%
39 -------------------------------------------------------------- -------------------------------------------------------------- 0%
40 -------------------------------------------------------------- ---------------------------------------------------------- 0%
41 -------------------------------------------------------------- ---------------------------------------------------------- 0%
42 -------------------------------------------------------------- ---------------------------------------------------------- 0%
43 -------------------------------------------------------------- ---------------------------------------------------------- 0%
44 -------------------------------------------------------------- ---------------------------------------------------------- 0%
45 -------------------------------------------------------------- ---------------------------------------------------------- 0%
46 -------------------------------------------------------------- ---------------------------------------------------------- 0%
47 -------------------------------------------------------------- ---------------------------------------------------------- 0%
48 -------------------------------------------------------------- ---------------------------------------------------------- 0%
49 -------------------------------------------------------------- ---------------------------------------------------------- 0%
50 -------------------------------------------------------------- ---------------------------------------------------------- 0%
51 -------------------------------------------------------------- ---------------------------------------------------------- 0%
52 11-May-22 9500 1500 30-May-22 9516 1500 ------------------------------------------- 3%
53 -------------------------------------------------------------- ---------------------------------------------------------- 0%
54 -------------------------------------------------------------- ---------------------------------------------------------- 0%
55 -------------------------------------------------------------- ---------------------------------------------------------- 0%
56 -------------------------------------------------------------- ---------------------------------------------------------- 0%
57 -------------------------------------------------------------- ---------------------------------------------------------- 0%
58 -------------------------------------------------------------- ---------------------------------------------------------- 0%
59 -------------------------------------------------------------- ---------------------------------------------------------- 0%
60 -------------------------------------------------------------- ---------------------------------------------------------- 0%
61 -------------------------------------------------------------- ---------------------------------------------------------- 0%
62 -------------------------------------------------------------- ---------------------------------------------------------- 0%
63 -------------------------------------------------------------- ---------------------------------------------------------- 0%
64 -------------------------------------------------------------- ---------------------------------------------------------- 0%
65 -------------------------------------------------------------- ---------------------------------------------------------- 0%
66 -------------------------------------------------------------- ---------------------------------------------------------- 0%
67 -------------------------------------------------------------- ---------------------------------------------------------- 0%
68 -------------------------------------------------------------- ---------------------------------------------------------- 0%
69 -------------------------------------------------------------- ---------------------------------------------------------- 0%
70 -------------------------------------------------------------- ---------------------------------------------------------- 0%
71 -------------------------------------------------------------- ---------------------------------------------------------- 0%
72 -------------------------------------------------------------- ---------------------------------------------------------- 0%
73 -------------------------------------------------------------- ---------------------------------------------------------- 0%
74 -------------------------------------------------------------- ---------------------------------------------------------- 0%
75 -------------------------------------------------------------- ---------------------------------------------------------- 0%

76 1-Aug-22 10000 20000 22-Aug-22 10008 2000 ------------------------------------------- 2%

77 -------------------------------------------------------------- ---------------------------------------------------------- 0%
78 -------------------------------------------------------------- ---------------------------------------------------------- 0%
79 -------------------------------------------------------------- ---------------------------------------------------------- 0%
80 -------------------------------------------------------------- ---------------------------------------------------------- 0%
81 -------------------------------------------------------------- ---------------------------------------------------------- 0%
82 -------------------------------------------------------------- ---------------------------------------------------------- 0%
83 -------------------------------------------------------------- ---------------------------------------------------------- 0%
84 -------------------------------------------------------------- ---------------------------------------------------------- 0%
85 -------------------------------------------------------------- ---------------------------------------------------------- 0%
86 -------------------------------------------------------------- ---------------------------------------------------------- 0%
87 -------------------------------------------------------------- ---------------------------------------------------------- 0%
88 -------------------------------------------------------------- ---------------------------------------------------------- 0%
89 -------------------------------------------------------------- ---------------------------------------------------------- 0%
90 -------------------------------------------------------------- ---------------------------------------------------------- 0%
91 -------------------------------------------------------------- ---------------------------------------------------------- 0%
92 -------------------------------------------------------------- ---------------------------------------------------------- 0%
93 -------------------------------------------------------------- ---------------------------------------------------------- 0%
94 -------------------------------------------------------------- ---------------------------------------------------------- 0%
95 -------------------------------------------------------------- ---------------------------------------------------------- 0%
96 -------------------------------------------------------------- ---------------------------------------------------------- 0%
97 -------------------------------------------------------------- ---------------------------------------------------------- 0%
98 -------------------------------------------------------------- ---------------------------------------------------------- 0%
99 -------------------------------------------------------------- ---------------------------------------------------------- 0%

100 24-Oct-22 10500 500 9016 500 ------------------------------------------- -297%

101 -------------------------------------------------------------- ---------------------------------------------------------- 0%

102 -------------------------------------------------------------- ---------------------------------------------------------- 0%
103 -------------------------------------------------------------- ---------------------------------------------------------- 0%
104 -------------------------------------------------------------- ---------------------------------------------------------- 0%
105 -------------------------------------------------------------- ---------------------------------------------------------- 0%
106 -------------------------------------------------------------- ---------------------------------------------------------- 0%
107 -------------------------------------------------------------- ---------------------------------------------------------- 0%
108 -------------------------------------------------------------- ---------------------------------------------------------- 0%
109 -------------------------------------------------------------- ---------------------------------------------------------- 0%
110 -------------------------------------------------------------- ---------------------------------------------------------- 0%
111 -------------------------------------------------------------- ---------------------------------------------------------- 0%
112 -------------------------------------------------------------- ---------------------------------------------------------- 0%
113 -------------------------------------------------------------- ---------------------------------------------------------- 0%
Catatan : Note :
1. Service terakhir sampai ke waktu Commisioning tidak boleh melebihi 1 X interval service.
2. Jika terjadi selisih Rencana + 20% maka harus membuat PICA.

Tanjung, 20 Desember 2022

Dibuat Oleh, Di Review Oleh, Disetujui Oleh, Diketahui Oleh,

Aries Faruna Sabjanto

PLANT PT.RMI SHE KO PT.RMI SHE KO PT.SIS Keselamatan Operasi PT Adaro Indonesia
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F-AI-OHS-08-090 Rev.01
 REKAP PEMELIHARAAN SARANA, PRASARANA, INSTALASI DAN PERALATAN
Perusahaan : PT Adelian Karya Putri 1 Tipe Unit : Mini Bus 4
Periode Pemeliharaan : 05 September 2021 - 05 September 2022 2 Kode Unit : A-555 5
HM/KM Actual : 97710 3 S/N Unit : S455554666 6

Pemeliharaan Terjadwal Selesih Rencana

Pemeliharaan Tidak Terencana
Rencana Pemeliharaan Realisasi Pemeliharaan dengan Aktual
No. Keterangan Perbaikan Status
Tanggal HM / KM Interval Servis Tanggal HM / KM Interval Servis Tanggal HM / KM HM / KM / Hari

3 7 8 9 10 11 12 13 14 15 16
1 6-Sep-22 500 500 3-Mar-22 505 500 01 September 2021 5 - Komplet
2 ---------------------------------------------------------------------------------------------------------------------- 0
3 3-Jun-22 1000 509 3-Jun-22 999 1000 -1
4 4-Aug-22 1500 500 3-Mar-22 1495 500 -5
5 3-Jun-22 2000 1000 3-Mar-22 2005 500 5
6 3-Jun-22 2000 1000 3-Mar-22 2005 500 5
7 0
8 0
9 0
10 0

Catatan :

………...…………… , ………….…………….. 20..

Dibuat Oleh, Direview Oleh, Disetujui Oleh, Diketahui Oleh,

Sumitro Binsar Marasi Dimas Cahyo Kencono Yuni Santoso

Planner PT. MBK KO PT. Maju Bersama Kita PJO - PT. Maju Bersama Kita Keselamatan Operasi PT Adaro Indonesia
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F-AI-OHS-08-090 Rev.01
 LOGO
PERUSAHAAN
REKAP PERAWATAN SARANA, PRASARANA, INSTALASI DAN PERALATAN
Perusahaan : 0
Periode : 1
HM Actual : 2

Perawatan Terakhir Perawatan Selanjutnya Perawatan Tidak Terencana

No. Tipe Unit Kode Unit S/N Unit Keterangan Perbaikan Status
Tanggal HM / KM Tipe Tanggal HM / KM Tipe Tanggal HM / KM
3 4 5 6 7 8 9 10 11 12 13 14 15 16
31-Dec-99 0 0 1-Mar-20 500 500 -------------------------------- penamban oli mesin 5liter close
---------------------------------------------------------------------------------------------------- 1-Jan-00 322 pegencangan Trod close
---------------------------------------------------------------------------------------------------- 2-Jan-00 400 ganti sit belt close
3-Mar-22 505 500 3-Jun-22 1000 1000 -------------------------------- - close
3-Jun-22 999 1000 4-Aug-22 1500 500 -------------------------------- - close
3-Mar-22 1495 500 3-Jun-22 2000 1000 -------------------------------- - close

………...…………… , ………….…………….. 20..

Dibuat Oleh, Direview Oleh, Disetujui Oleh, Diketahui Oleh,

Dibuat oleh perusahaan pemilik Di isi oleh User PJA/PJO

PT. . . . . . . . . . . . . . . . . . . . . . . Keselamatan Operasi PT. PT. . . . . . . . . . . . . . . . . . . . . . . Keselamatan Operasi PT Adaro Indonesia
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F-AI-OHS-08-090 Rev.01