MANTAN PRIMA PERSADA

Contractor & Mining

KPP Developer

(QA7 & QA1) MACHINE INSPECTION REPORT

MACHINE WHEN INSPECTED
MODEL CODE NUMBER DATE HOUR METER

KSB19

COMP NO ITEM TO BE CHECK CHECK POINT

1 Radiator core & Fin,cap,strainer and pressure valve Dirty,leak,clogged,damage

2 Water level sensor Mulfunction (Check condition @ 4000 HR)

SAFETY TANK
RADIATOR &

3 Safety tank level Clogged,crack,cap lost,mulfunction

4 Water Pump,Corrossion filter and valve Leak,mulfunction

5 Hose and pipe connection Leak,crack,loose,deformation

6 Fan balde,Puly,V-belt and tension pully Loose,damage,worn out,

7 Water temp.sensor and cable Damage,lost,mulfunction,disconnection

1 Lubrication oil Leveland plug connection

2 Lub.oil piping and hoses Leak,loose,crack,deformation

3 Air cleaner,rubber and connection Clogged,crack,cap lost,deformation

4 Exh.manifold,mufler,mounting bolt and temp.sensor Leak,loose,crack,deformation

5 Turbocharger,clamp and mounting bolt Leak,loose,crack,unusual noise

6 Cyl.head,return fuel line,rocker arm cover Leak,loose,unusual noise

ENGINE

7 Cyl.Block,Oil cooler,front seal,oil pressure sensor Leak,crack

8 Oil filter,bracket,piping and hoses Leak,loost,damage,deformasion

9 Fuel filter,fuel line,fuel tank,water sparator & breather Leak,loost,damage,deformasion

10 Fuel Pump,coupling and mounting bolt Leak,crack,loose,lost,

Unusual noise,leaking,Low power,Black
11 Running Test
smoke,
12 Water temperature Over heat,over cool
13 Exhaust smoke and temperatur Excess color (black,blue,white) and too High

1 Battery electrolit Level,deterioration

2 Battery,clamp and cable connection Low current,loose,crack,dirty

ELECTRICAL

3 Battery relay,St.motor,Alternator,St.Switch Damage,mulfunction

SYSTEM

4 Gauge,pannel lamp,fuse,relay and wiring connection Damage,loose,mulfunction

5 Lock Off switch and wiring Function and connection

6 Service meter Damage,mulfunction

7 Warning lamp,working lamp,turn lamp,brake lamp,Rotary lamp Damage,mulfunction

1 Grease lubricating Level,deterioration
AUTOLUBE

2 Botle,Pump and mounting bolt Leak,Clogged,crack,loose

3 Piping,hoses,distributor and mounting bolt Leak,Clogged,crack,loose
4 Setting timer Over,low,mulfunction
MANTAN PRIMA PERSADA
Contractor & Mining
KPP Developer

(QA7 & QA1) MACHINE INSPECTION REPORT

MACHINE WHEN INSPECTED
MODEL CODE NUMBER DATE HOUR METER

KSB19

COMP NO ITEM TO BE CHECK CHECK POINT

1 Breather bare, shaft pump Clogged,crack,cap lost,deformation

2 Intake & exhaust vacuum Leak,loose,crack,deformation

3 Lube oil and grease leak main pump Leak,crack,loose,deformation

4 Water leaks for main pump Leak,loose,crack,deformation

5 Hose bolts tightness loose,lost,deformation

ATTACHMENT

6 Vacuum gauge Damage,mulfunction

7 Gland Packing Leak,crack

8 Butterfly valve leaks Leak,crack,loose,deformation

9 Main pump bearing, Vacuum pump bearing, lost,crack,unusual noise

10 Krundiment valve Leak,crack,loose,deformation

11 Non return valve Leak,crack,loose,deformation

12 Guarding Crack, lost

Mechanic comment :

V : Good Condition
Notes :

Approved by, Inspect

X : Bad Condition
( ) (
NA: Not Aplicable G.Leader Me
 Form No. S.2.2.030/FRM
Rev : 00

ECTION REPORT

CONDITION WATER PUMP

QA 7 QA 1 REMARKS
 Form No. S.2.2.030/FRM
Rev : 00

ECTION REPORT

CONDITION WATER PUMP

QA 7 QA 1 REMARKS

Inspected QA 7 by, Inspected QA 1 by,

( ) ( )
Mechanic Mechanic
Page 1 / 6
 PT PAMAPERSADA NUSANTARA Form No. S.2.2.030/FRM
MINING CONTRACTOR

MANTAN PRIMA PERSADA

Contractor & Mining Rev : 00
KPP
Developer

PERIODICAL SERVICE FORM

WATER PUMP

ENGINE MODEL :
CODE NUMBER : KSB19
PS I PS II PS III PS IV PIC

WORK ORDER NUMBER

HOUR METER
SERVICE

Mechanic
DATE

START TIME

FINISH TIME

MAN POWER QTY PS

START TIME ALL ACTIVITIES

ACTIVITIES
LEAD TIME

WASHING UNIT (HOUR)

Mechanic
SERVICE TIME (HOUR)

WASHING AFTER SERVICE (HOUR)

FINISH TIME ALL ACTIVITIES (RFU TIME)

Mec.
PAP ENGINE OIL (QTY BOTTLE)

FILLED BY GROUP LEADER PS I PS II PS III PS IV PIC

TOTAL DOWN TIME (HOUR)

GL
MANHOUR PS (HOUR)

FINAL CHECK (dilakukan setelah PS) ACTIVITY PS I PS II PS III PS IV PIC

1 WALK AROUND CHECK RECHECK

2 OIL LEVEL RECHECK

3 FILTERS TIGHTNESS & LEAKAGE RECHECK

4 OIL & FUEL CAP TIGHTNESS RECHECK

5 DRAIN PLUG TIGHTNESS & LEAKAGE RECHECK

6 BACKLOG REPAIR QUALITY RECHECK

7 WATERCOOLANT LEVEL RECHECK GROUP LEADER

8 PANEL, WARNING LAMP & BUZZER RECHECK

9 START ENGINE, CHECK NOISE RECHECK

10 WORKLAMP, SIGNAL LAMP RECHECK

11 WORK EQUIPMENT FUNCTION RECHECK

12 OIL/WATER/FUEL LEAKAGE RECHECK

NAME

SIGN

Page 2 / 6
 Form No. S.2.2.030/FRM

KALIMANTAN PRIMA PERSADA

Contractor & Mining Rev : 00
KPP
Developer

PERIODICAL SERVICE FORM

WATER PUMP
DnD200
HM
CODE NUMBER : KSB19 Mech.

EVERY 250 HOURS ACTIVITY STD PS I PS II PS III PS IV PIC

1 ENGINE OIL CHANGE 30

2 OIL FILTER REPLACE 15

3 FUEL FILTER REPLACE 15

4 RADIATOR COOLANT CHECK BY C/TESTER 5

5 AIR CLEANER CHECK / CLEAN 15

6 DUST INDICATOR CHECK 3

7 EXHAUST SYSTEM LEAKAGE AND CLAMP BOLTS CHECK 5

8 ENGINE RUBBER MOUNTING BOLTS CHECK 5

9 FAN BELT TENSION INSPECT & ADJUST 5

10 ALTERNATOR V-BELT INSPECT & ADJUST 5

11 RUBBER COUPLING MAIN PUMP CHECK / REPLACE 10

12 CLUTCH VACUUM PUMP CHECK / REPLACE 15

13 BELT VACUUM PUMP INSPECT & ADJUST 10

14 VACUUM PUMP MOUNTING FOR TIGHTNESS CHECK & RETIGHTEN 10

MECHANIC
15 BARE SHAFT PUMP LUBRICATE 5

16 NON RETURN VALVE CHECK CONDITION 5

17 DRIVE COUPLING CHECK CONDITION 5

18 VACUM TANK PROBES (VACTRONIC & WATERLOSS) CHECK/CLEAN 10

ELECTRICAL

STARTING & CHARGING SYSTEM

19 STARTING MOTOR CHECK 5

20 BATTERY ELECTROLYTE CHECK / REFILL 3

21 BATTERY TERMINAL CLEAN & CHECK 3

22 ALTERNATOR CHECK / REPLACE 5

23 WIRING HARNESS, MONITOR PANEL, VACTRONIC MODUL CHECK & REPAIR 10

24 COIL & CLUTCH VACUUM PUMP CHECK & REPAIR 5

25 CABLE PROBE CHECK & REPAIR 5

26 ROTARY LAMP CHECK 3

27 WORK LAMP CHECK & REPLACE 5

28 LOCK OUT CHECK 3

29 EMERGENCY STOP CHECK 3

EVERY 500 HOURS ACTIVITY STD PS II PS IV PIC

ENGINE

FUEL SYSTEM

30 FUEL LINE LEAKS AS PIPING,HOSES,FUEL TANK CHECK & REPAIR 10

AIR INTAKE & EXHAUST SYSTEM

31 AIR LINE FOR CLAMP & HOSE CHECK / REPAIR 10

32 TURBOCHARGER CHECK & REPLACE 10

33 AIR INTAKE & EXHAUST FOR LEAKS CHECK / REPAIR 10

34 MUFFLER BRACKET & CLAMP CHECK & RETORQUE 10

COOLING SYSTEM
MECHANIC

35 WATER LINE FOR HOSE, PIPE & CLAMP CHECK/REPLACE 10

36 RADIATOR CORE CHECK/CLEAN 10

37 RADIATOR MOUNTING FOR TIGHTNESS CHECK 10

38 FAN HUB CHECK & LUBRICATE 5

39 WATER PUMP CHECK / REPLACE 15

LUBRICATING SYSTEM

40 OIL LEAKS OF CYLINDER HEAD COVER CHECK & REPAIR 5

ATTACHMENT

41 BREATHER BARE SHAFT PUMP CHECK & REPLACE 5

42 MAIN WATER PUMP LEAKS CHECK & REPAIR 10

43 INTAKE & EXHAUST VACUUM CHECK & REPAIR 5

44 LUBRICATE OIL, GREASE LEAKS FOR MAIN PUMP CHECK & REPAIR 10

5.22

START

STOP

V Kotak checkmark sebagai tanda bahwa recheck telah dilakukan untuk critical item Page 3 / 6
MANTAN PRIMA PERSADA
Contractor & Mining
KPP Developer

PERIODICAL
WATER PUM
DnD200

INSPECTION REPORT CODE NUM

Part Number No.
No HM Problem Description Component Part Description No. Figure
Required Index
 Form No. S.2.2.030/FRM

Rev : 00

RIODICAL SERVICE FORM

TER PUMP
D200

DE NUMBER : KSB19
Inspection Plan Repair Plan Repair Status
Qty
Date Date Duration (Hour) (BL/Close)
Page 4 / 6
 Form No. S.2.2.030/FRM

MANTAN PRIMA PERSADA

Contractor & Mining Rev : 00
KPP
Developer

PERIODICAL SERVICE FORM

WATER PUMP
DnD200
HM
CODE NUMBER : KSB19 Mech.

EVERY 1000 HOURS ACTIVITY STD PS I PS II PS III PS IV PIC

1 ALL BOLTS HOSES TIGHTNESS CHECK & RETORQUE 5
2 VACUUM GAUGE CHECK & REPLACE 3
3 VACUUM PUMP OIL CHANGE 20
4 GLAND PACKING CHECK & REPLACE 15
5 BUTTERFLY VALVE LEAKS CHECK & REPAIR 15
6 BARE SHAFT PUMP (IMPELLER,WEAR PLATE) CHECK CONDITION 15
7 VACTRONIC CONTROL CHECK CONDITION 5
8 AUTO SHUTDOWN CHECK FUNCTION 3
EVERY 2000 HOURS ACTIVITY STD PS IV PIC
ENGINE
9 WATER COOLANT CHANGE 20
10 AIR CLEANER REPLACE 15

MECHANIC
ATTACHMENT
11 BEARING MAIN PUMP NOISE VISUAL CHECK 3
12 BEARING VACUUM PUMP NOISE VISUAL CHECK 3
13 KRUNDIMENT VALVE CLEAN 15
14 NON RETURN VALVE CHECK / REPLACE 10
2.45

START

STOP

V Kotak checkmark sebagai tanda bahwa recheck telah dilakukan untuk critical item

Page 5 / 6
MANTAN PRIMA PERSADA
Contractor & Mining
KPP Developer

PERIODICAL
WATER PUM
DnD200

INSPECTION REPORT CODE NUM

Part Number No.
No HM Problem Description Component Part Description No. Figure
Required Index
 Form No. S.2.2.030/FRM

Rev : 00

RIODICAL SERVICE FORM

TER PUMP
D200

DE NUMBER : DnD200
Inspection Plan Repair Plan Repair Status
Qty
Date Date Duration (Hour) (BL/Close)
Page 6 / 6