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FORM / FORMULIR |
No. Dokumen |
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GSI4-OPR-002N |
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| Revisi |
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0 |
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| P2H |
Tanggal Efektif |
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18-Sep-24 |
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| KENDARAAN LV |
Halaman |
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1 |
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NAMA DRIVER |
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Dally andi pamungkas |
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SHIFT |
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Malam |
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DEPARTEMEN |
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PAM |
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NO. ALAT |
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LV.002 |
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TANGGAL |
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2025-12-23 |
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KM AKHIR |
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187894 |
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KETERANGAN : |
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1. |
Pada kolom
"Kondisi" beri tanda ( ✔ ) sesuai dengan kondisi kendaraan pada
saat pemeriksaan |
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2. |
Tuliskan
di kolom catatan, apabila ada informasi tambahan mengenai kerusakan /
ketidaksesuaian yang ditemukan |
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3. |
Bila
ditemukan dari pemeriksaan ada temuan Rusak dan perlu dilengkapi segera
laporkan ke Pengawas/Mekanik |
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| NO |
ITEM YANG
HARUS DIPERIKSA |
KODE |
KONDISI |
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ITEM YANG
HARUS DIPERIKSA |
KODE |
KONDISI |
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| BAIK |
Rusak / Tidak
Sesuai |
Tidak Ada |
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BAIK |
Rusak / Tidak
Sesuai |
Tidak Ada |
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| PEMERIKSAAN
KELILING UNIT / DILUAR KABIN |
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PEMERIKSAAN KELILING UNIT / DILUAR KABIN |
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| 1 |
Level Oli Transmisi |
AA |
✔ |
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16 |
Kemudi (Steering) |
AA |
✔ |
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| 2 |
Air Radiator |
AA |
✔ |
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17 |
Rem Tangan |
AA |
✔ |
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| 3 |
Level Oli Kemudi |
AA |
✔ |
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18 |
Rem Kaki |
AA |
✔ |
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| 4 |
Level Oli Engine |
AA |
✔ |
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19 |
Klakson |
AA |
✔ |
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| 5 |
Level Oli Rem |
AA |
✔ |
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20 |
Panel Indikator/Gauge |
AA |
✔ |
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| 6 |
Level Oli Perseneling |
AA |
✔ |
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21 |
4WD Double Gardan |
AA |
✔ |
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| 7 |
Body Unit |
AA |
✔ |
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22 |
Wipers |
AA |
✔ |
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| 8 |
Ban, Baut Roda |
AA |
✔ |
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23 |
Radio Rig |
AA |
✔ |
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| 9 |
Kaca Spion |
AA |
✔ |
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24 |
Seat Belt |
AA |
✔ |
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| 10 |
Alarm Mundur |
AA |
✔ |
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25 |
Tempat Duduk |
A |
✔ |
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| 11 |
Lampu Rem & Sein |
AA |
✔ |
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26 |
Dongkrak |
A |
✔ |
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| 12 |
Lampu Depan |
AA |
✔ |
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27 |
Ganjal Roda |
A |
✔ |
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| 13 |
Lampu Rotary |
AA |
✔ |
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28 |
Kebersihan Kabin |
A |
✔ |
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| 14 |
Air Wiper dan Air Aki |
A |
✔ |
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29 |
Kunci Baut Roda |
A |
✔ |
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| 15 |
Tiang Bendera |
A |
✔ |
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30 |
APAR |
A |
✔ |
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| PENTING : |
1. |
Kode Bahaya A: |
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Unit harus diperbaiki
sebelum di operasikan |
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2. |
Kode Bahaya AA: |
Berhenti
dan SEGERA Laporkan Keatasan, putuskan lanjutkan atau perbaiki segera |
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3. |
Mengoperasikan alat
dengan kerusakan AA akan dikenakan sanksi sesuai Peraturan Perusahaan |
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| CATATAN : Tuliskan bila ada temuan dan kelainan selain item
diatas |
DIISI OLEH, |
DIPERIKSA OLEH, |
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| Foglamp off
Mining led nothing
Wheelcock nothing
Bot wheel RH RR nothing 1
Abs RR LH abnormal
Actuator tranfer 4x4 abnormal
Sensor fuel filter abnormal
Sensor pump stering abnormal
Mounting engine RH LH Crack
Center bearing propeller shaft RR crack
Rubber front diffrential Crack
Regulator PW RR LH Abnormal
Sound system RR LH Off
Turbo charge Leak
Tail gate & Lock pintu belakang Broken
Hand Brake need for adjust |
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| Dally andi pamungkas |
Muh. Zakariah Fitra |
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| TTD DRIVER |
TTD PENGAWAS |
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