DOZER INSPECTION CHECK LIST

Product Identification : Company :

Model No : Contract No :
Engine No : Date of Inspection :
Frame No : Location of Inspc :

No. ITEM CHECKED / BAGIAN YANG DIPERIKSA Remarks

A DRIVER INFORMATION / Informasi Pengemudi

1 Name of Operator / Nama Operator

2 Operator Licence Number / No SIO Operator

3 Class of Driving Licence / Jenis SIO

4 Expire Licence / Masa Berlaku SIO

B VEHICLE INFORMATION / Informasi Kendaraan

1 Licence Plate / Nomor Polisi

2 SILO Valid to / Masa Berlaku SILO

3 Type of Vehicle-Merk /Tipe Kendaraan - Merek

4 Year of Built / Tahun pembuatan

ITEM CHECKED Availability Condition
No. Remarks
BAGIAN YANG DIPERIKSA Yes No Good Fair Poor
Ada Tidak Bagus Kurang Jelek
C VEHICLE CONDITION / Kondisi Kendaraan
1 Km Driven / Kilometer tempuh

2 Glass / Kaca:

2.1 Windshield / Kaca depan

2.2 Rear Window / Kaca belakang

2.3 Side Window / Kaca samping

Windshield wiper / karet pembersih kaca depan

3 Mirror / Spion

3.1 Side / Samping

- Left / Kiri

- Right / Kanan
No. ITEM CHECKED / BAGIAN YANG DIPERIKSA Remarks

4 Light / Lampu

4.1 Head / Depan

4.2 Tail / Belakang

4.3 Parking / Parkir

4.4 Indicator - Sign / Signal

4.5 Break / Rem

4.6 Rotary Lamp / lampu putar

5 Door Condition / Kondisi pintu

6 Valve Tire Cap / Penutup lubang angin ban

7 Gas / fuel tank door / lid - Gas / Penutup tanki bahan bakar

8 Fuel tank, any leak ? / Tangki bahan bakar, ada kebocoran?

9 Engine / Mesin

10 Exhaust / Knalpot

11 Accu / Aki Electric System

12 Horn / Klakson

13 Safety belt / Sabuk pengaman

14 Speedometer / Speedometer
15 Break / Rem
16 Fuel indicator / Indikator bahan bakar

17 Gross Power / Kemampuan ( Maks): 74 kw / 99 HP

18 Flywheel Power / Tenaga Flywheel: 67 kW / 90 HP

19 Operating Weight / Beban Operasi : 8,735 KG / 19,256 Lbs

20 Blade Capacity / Kapasitas pisau : 2.08 M3 / 2.70 yd3

Power Angling and Tilt Blade / Kemampuan kemiringan
21
mata pisau: 2.69 M / 8' 9.9"
Transmission : Planetary Power Shift & Torque Converter /
22 Transmisi : menggunakan pergeseran maju -mundur dan
tenaga putaran
Winch completed with Winch Cable and Hook / Penderek
23
komplit dengan kawat sling dan pengait
24 Operational Winch System / Pengoperasian sistim derek

25 Winch Cable / Kawat sling penderek

Heavy Duty Cable / Sling Hook / Kawat sling untuk beban
26
berat yang ada pengait
27 Cutting Blades / Pisau Pemotong
Engine : Turbo Charged Diesel Engine / Mesin menggnakan
28
mesin turbo
No. ITEM CHECKED / BAGIAN YANG DIPERIKSA Remarks

1 ea 6 Meter x 7/8" heavy duty chain c/w 2 ea cleaves grab

hook on each chain / 1 buah, 6 M x 7/8" rantai pengikat
29
beban berat dengan 2 buah pengunci pengikat yg ada
pengait
2 each 5/8" Crosby anchor shackles / 2 Buah 5/8" Shakle
30
Crosby
2 each 7/8" Crosby anchor shackles / 2 Buah 7/8" Shakle
31
Crosby
2 ea 3 m x 4" Wide nylon sling belt / 2 ea 3 m x lebar 4"
32
sabuk sling nylon
33 Nut & Bolt Tire / Baut dan Mur Roda

34 V-Belt Engine / V - belt mesin

35 Transmission System / Sistim transmisi

36 Fire Extinguisher / Racun api

37 Manufacture’s Tool Kit / Perkakas

38 Vehicle Jack / Dongkrak

39 Safety Triangle / Segitiga pengaman

40 First Aid / P3K

41 Operator & Helper PPE / PPE Operator dan pembantunya

- Mechanical findings :

- Overall condition : GOOD FAIR POOR

- Conclusion 1. Meet / Not meet contract spec.

2. Meet contract spec but on condition (specify) :

Inspected by,

Operator Supervisor Area Inspector HSE Supervisor