/Unit / No : HM / KM Akhir : Hari / Tanggal : Shift :
Pemeriksaan Bahan Bakar, Pelumas Grease dan Roda
No Subyek Cukup Kurang Keterangan 1 Fuel / Bahan Bakar 2 Water / Air Radiator 3 Air Aki / Baterry 4 Oli Mesin 5 Oli Transmisi 6 Oli Hydraulic 7 Oli Differential 8 Oli Swing 9 Oli Pivot Shaft
No Subyek Cukup Kurang Keterangan
10 Minyak Rem 11 Gemuk 12 Tekanan Ban 13 Baut Roda 14 APAR 15 Safety Belt 16 Rambu 17 Vessel 18 Tangga / Foot Step
Pemeriksaan Componen Unit
No Subyek Baik Rusak Keterangan 1 Van Belt (Tali Kipas) 2 Air Cleaner 3 Kabin 4 Service Meter 5 Kaca Spion 6 Klakson 7 Wiper 8 Lampu Depan 9 Lampu Belakang 10 Lampu Sign 11 Sistem Kemudi 12 Rem Parkir 13 Retarder 14 Drage Link 15 Exhaust Manipol 16 Spring / Suspensi 17 Tirod 18 Seat Spring 19 U-Bolt Spring 20 Torque Rod 21 Rubber Torque Rod 22 As / Cross Joint 23 Pemeriksaan Vessel
No Subyek Baik Rusak Keterangan
24 Gardan / Differential 25 Rubber Bushing Arm 26 Safety Dolly 27 Rubber End 28 Blade 29 Cutting Edge / End Bit 30 Blade Cylinder 31 Bucket 32 Teeth Bucket 33 Pin Bucket 34 Boom 35 Boom Cylinder 36 Arm 37 Arm Cylinder 38 Carrier Roller 39 Track Roller 40 Track Shoe 41 Shank Ripper 42 S. Ripper Protector 43 Point Ripper 44 Pin Ripper 45 Hose In-Out Mine Pump 46 Kondisi Tali Gate