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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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Ganil |
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SHIFT |
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Malam |
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DEPARTEMEN |
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HRGA-IT |
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NO. ALAT |
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LV.020 |
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TANGGAL |
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2026-04-13 |
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KM AKHIR |
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11537.4 |
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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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✔ |
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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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✔ |
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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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✔ |
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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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✔ |
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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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✔ |
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27 |
Ganjal Roda |
A |
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✔ |
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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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✔ |
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30 |
APAR |
A |
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✔ |
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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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| Bolam lampu senja kanan kiri mati. Tailgate terkunci permanent. Parking brake kurang pakem. Ada kretakan ringan pada kaca bagian depan kemudi. Indikator check engine aktif disertai indikator VSA. Pelapis kursi dan alas kantai sudah robek2. Sopatbor depan sebelah kiri hilang/jatuh. Cover bumper belakang hilang/jatuh. Apar rusak selangnya bocor. Minta pergantian fuel filter. |
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| Ganil |
Muh. Zakariah Fitra |
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| TTD DRIVER |
TTD PENGAWAS |
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