MONTHLYHEAVYEQUIPMENT-HEAVYTRUCKINS

Date of Inspection
Place/Location
Company Name

Fill "1" in the colom with "Compliance Items" and "0" for the
EQUIPMENT :
NUMBER
Police Number / SN :
NO Item's To Be Checklist Driver/ Operator :
Name

A Equipment / Truck Adm.

1 Driving Licence (SIM)

2 Driving Permit / Izin Mengemudi
3 SIO /SILO
4 EXPIRED DOCUMENT BOOKS / Masa berlaku buku Kir,STNK, Kartu Kendali
5 Pass Inspection (Lulus Inspeksi)
6 Security Gate Pass (pass Security)
7 Sticker Ladang Minyak
Sub Total
Compliance Percentage (%)
B Standard Safety Devices

1 SAFETY BELT / SEAT - DRIVER/OPERATOR / Sabuk Pengaman Sopir atau Operator

2 VIEW MIRRORS (SIDES & REAR) / Kaca Spion Kiri & Kanan
3 SIGNAL LIGHTS / Lampu pengarah
4 BRAKE LIGHTS / Lampu Rem
5 HEAD LIGHTS / Lampu Besar
6 BACK UP ALARM / Klakson Mundur
7 Reverse Lamp / Lampu Mundur
8 HORN / Klakson
9 WINDSHIELD WIPER , WINDSHIELD GLASS & DOOR GLASS / Kipas Kaca , Reben & Kaca pintu
10 PARKING BRAKES & SERVICE BRAKES / Rem Parkir & Rem kaki
11 ODOMETER ( KM READING ), HOUR METER / Ukuran Kilometer, Ukuran Jam mesin
12 DOOR LOCKS/CABIN LOCK / Kunci Pintu & Kunci Kabin
13 Wheel Chock / Ganjal Ban
14 Fire Extinguisher / Alat Pemadam Api Ringan
15 First Aid Kit (Obat P3K)
16 Spare Tire
17 Jack & Wheel wrench
Sub Total
Compliance Percentage (%)
C Limited Use

1 AMBER WARNING - HEAVY VEHICLE ONLY / Lampu pengaman- Alat berat saja
2 TRIANGLES , RED CONES , RED FLAGS Segitiga, Kerucut , Bendera Merah
3 CABIN CONDITION ( ENGINE SMOKE,WATER LEAKS,CORROSION ) Kondisi kabin ( Asap mesin , bocor, karatan )
4 Winch Cable
5 Hour Meter / Odo Meter
 Sub Total
Compliance Percentage (%)
D Mechanical / Need Assistance
1 CHECKED ENGINE OIL,TRANSMISSION OIL, HYDRAULIC OIL / Periksa minyak pelumas mesin, Transmisi, Hidrolik
2 CHECKED RADIATOR WATER, BATTERY LEVELS &TERMINALS / Periksa air radiator, Periksa air battery & Terminal
3 CHECKED DRIVE BELTS, BRAKE FLUID, FUEL / Periksa tali kipas, Minyak rem, Bahan Bakar / Diesel
4 CHECKED STEERING, SERVICE BRAKES, CLUTCH / Periksa steur, Rem kaki & Coupling
5 CHECKED TIRE, WHEEL NUTS, SPRING, A.C / Periksa ban, Baut roda, Per, S.pendingin
6 CHECKED BODY, DUMP BODY, ENGINE HOOD / Periksa bodi, Bak bodi, Tutup mesin
7 Air Gauge / Oil / Temperature Gauge (Amper udara, pelumas dan suhu)
8 Track Shoes / Bolts / Connection Link (Roda penarik, Baut/sambungan)
9 Sprocket / Idler / Rollers
Sub Total
Compliance Percentage (%)
Grand Total
Total Compliance Percentage (%)
Note:1. If Compliance Percentage in 70% -100% : Relese to Operation. 2. If Compliance Percentage Less then 7
Safety Devices Items, wil be zero tolerance, should be SWA/SSWA until fixed. 4. Eventhough the Total Complia
70%, but the Compliance Percentage Less then 70%, should SWA/SSWA Implemented.

Recommendation:
1 Equipment Continue Operation
2 Equipment Need Repairing and Continue Operation
3 Equipment Stop Operation due to Unsafe Contion to Operated.
Inspected by:
Name Badge Company Department
HEAVYTRUCKINSPECTIONCHECKLIST

s" and "0" for the "Non Compliance Item" cheklisted

No
Good N/A Remarks
Good

ocor, karatan )
smisi, Hidrolik
ttery & Terminal
l

ercentage Less then 70% : Conducted SWA/SSWA until finished repairing/replacement. 3. For the
ugh the Total Compliance more then

Equipment Number

Signed
MONTHLYHEAVYEQUIPMENT-HEAVYTRUCKINSPECTIONCHECKLIST

Date of Inspection :
Place/Location :
Company Name :
Fill "1" in the colom with "Compliance Items" and "0" for the "Non Compliance Item" cheklisted
e Item" cheklisted