PT.

MARKA INSPEKTINDO TECHNICAL

(MARINDOTECH)
CHECK LIST OF SAFETY DEVICE
FOR PRESSURE VESSEL
EXISTING INSTALASI
Report No. :
Owner :
User :
Location :
Date Of Inspection :
Tag. No/Series No. : /
Description :
Type/Size : /
Year Built/Year Used :
M.A.W.P :
Max. Temp. :
SKPP MIGAS No. :

Condition
No. Descriptions Remarks
S/NS
1 Name Plate
2 Level Gauge
3 Pressure Indicator
4 Temperature Indicator
5 PSL / PAL Setting Point :
6 PSLL / PALL Setting Point :
7 PSH / PAH Setting Point :
8 PSHH / PAHH Setting Point :
9 LSH / LAH Setting Point
10 LSHH / LAHH Setting Point :
11 LSL / LAH Setting Point
12 LSLL / LALL Setting Point :
13 TSL / TALL Setting Point :
14 TSLL / TALL Setting Point :
15 Gas Detector :
16 Water Spay / Water Sprinkler
17 PSV Setting Point
18 Ladder
19 Foundation
20 Drainage
21 Grounding
22 Lightning Arrestor
23 Painting
 24 Interface Level Indicating Control
25 Insulation
26 Bolt & Nut
S : Satisfactory
NS : Not Satisfactory

Inspected by :

( )
 MIT-F06-01-02-06A
Revisi 03
8/24/2017

CHECK LIST OF SAFETY DEVICE

FOR PRESSURE VESSEL
EXISTING INSTALASI

Remarks
 PT. MARKA INSPEKTINDO TECHNICAL

(MARINDOTECH)
SAFETY DEVICE CHECK LIST
FOR PUMP/COMPRESSOR
EXISTING INSTALASI
Report No :
Owner :
User :
Date Of Inspection :
Location :
Tag No./ Serial No. : /
Description :
Manufacture :
Model/Type : /
Size Dia. (mm) :
Year Built/Year Used :
Pressure Design :
RPM :
SKPP MIGAS NO. :

Condition
No. Descriptions Remarks
S/NS
1 Name Plate
2 Painting
3 Grounding
4 Bolt & Nut Condition
5 Grouting
6 Lightning Arrestor
7 PSV Setting Point
8 Press. Indicator Installed
9 Temp. Indicator Installed

S : Satisfactory
NS : Not Satisfactory

Inspected by

( )
 MIT-F06-01-02-06B
Revisi 03
8/24/2017

SAFETY DEVICE CHECK LIST

FOR PUMP/COMPRESSOR
EXISTING INSTALASI

Remarks
 PT. MARKA INSPEKTINDO TECHNICAL

(MARINDOTECH)
CHECK LIST OF SAFETY DEVICE
FOR POWER GENERATOR
EXISTING INSTALASI
Report No. :
Owner :
User :
Date Of Inspection :
Location :
Tag/Serial No. : /
Description :
Manufacture :
Capacity :
Volt/Frequency : /
RPM/Phase/Cos Q : /
Year Built/Use :
SKPP Migas No. :

Condition
No. Description Remarks
S/NS
1 Name Plate
2 Foundation
3 Pressure Indicator
4 Bolt & Nut Condition
5 Temperature Indicator
6 Indicator Light
7 Grounding
8 Level Oil Indicator
9 RPM Indicator
10 Safety Personnel Warning Sign
11 Emergency Stop

S : Satisfactory
NS : Not Satisfactory

Inspected by
( )
 MIT-F06-01-02-06C
Revisi 03
8/24/2017

CE

Remarks
 PT. MARKA INSPEKTINDO TECHNICAL

(MARINDOTECH)
SAFETY DEVICE CHECK LIST
FOR MOTOR CONTROL CENTER (MCC)
EXISTING INSTALASI
Report No :
Owner :
User :
Date Of Inspection :
Location :
Tag No. / Serial No. : / -
Description :
Manufacture :
Capacity :
Volt :
Frequency :
Phase :
Year Built/Use :
SKPP Migas No. :

Condition
No. Descriptions
S/NS
1 Name Plate
2 Bust Duct
3 Isolator
4 Pannel Box
5 Indicator Light
6 Voltmeter
7 Ammeter
8 Grounding
9 Circuit Breaker (CB)

S : Satisfactory
NS : Not Satisfactory

Inspected by

( )
 MIT-F06-01-02-06D
Revisi 03
8/24/2017

MCC)

Remarks
 PT. MARKA INSPEKTINDO TECHNICAL

(MARINDOTECH)
SAFETY DEVICE CHECK LIST
FOR SWITCHGEAR
EXISTING INSTALASI
Report No :
Owner :
User :
Date Of Inspection :
Location :
Tag No. / Serial No. : / -
Description :
Manufacture :
Capacity :
Volt :
Frequency :
Phase :
Year Built :
SKPP Migas No. :

Condition
No. Descriptions Remarks
S/NS
1 Name Plate
2 Bust Duct
3 Isolator
4 Pannel Box
5 Indicator Light
6 Voltmeter
7 Ammeter
8 Grounding
9 Circuit Breaker (CB)

S : Satisfactory
NS : Not Satisfactory

Inspected by

( )
 MIT-F06-01-02-06F
Revisi 03
8/24/2017

Remarks
 PT. MARKA INSPEKTINDO TECHNICAL

(MARINDOTECH)
CHECK LIST OF SAFETY DEVICE
FOR TRANSFORMER
EXISTING INSTALASI
Report No. :
Owner :
User :
Date Of Inspection :
Location :
Tag/Serial No. :
Description :
Manufacture :
Capacity :
Volt/Frequency :
RPM/Phase/Cos Q :
Year Built/Use :
SKPP Migas No. :

Condition
No. Description Remarks
S/NS
1. Name Plate
2. Foundation
3. Pressure Oil Indicator
4. Bolt & Nut Condition
5. Temperature Indicator
6. Grounding
7. Level Oil Indicator
8. Lightning Arrestor
9. Safety Personnel Warning Sign

S : Satisfactory
NS : Not Satisfactory

Inspected by

( )
MIT-F06-01-02-06E
Revisi 03
8/24/2017

Remarks
 PT. MARKA INSPEKTINDO TECHNICAL

(MARINDOTECH)
SAFETY DEVICE CHECK LIST
FOR PSV/PRV
EXISTING INSTALASI
Report No. :
Owner :
User :
Date Of Inspectiopn :
Location :
Tag No. :
Description :
Fabricator :
Type/size : /
Year Built/Year Used :
M.A.W.P :
SKPP MIGAS No. :

Condition
No. Descriptions Remarks
S/NS
1
Name Plate
2
Seal MIGAS
3
Painting
4
Bolt & Nut
5
Cup
S : Satisfactory
NS : Not Satisfactory

Inspected by :

( )
 MIT-F06-01-02-06G
Revisi 03
8/24/2017

SAFETY DEVICE CHECK LIST

FOR PSV/PRV
EXISTING INSTALASI

Remarks
 PT. MARKA INSPEKTINDO TECHNICAL

(MARINDOTECH)
CHECK LIST OF SAFETY DEVICE
FOR STORAGE TANK
EXISTING INSTALASI
Report No. :
Owner :
User :
Date Of Inspection :
Location :
Tag. No : /
Size :
Capacity :
P&I Drawing :
SKPP Migas No. :
Condition
No Description Remarks
S/NS
1 Name Plate
2 Foundation
3 Drainage
4 Slot Deeping
5 Grounding
6 Lightning Arrestor
7 Painting
8 Insulation
9 Level Indicator
10 Breather Valve & Vent
11 Bolt & Nut
12 Ladder/Stairway
13 Handrail
14 Flame Arrestor
15 Water Spray
16 Damwall
17 Foam Chamber

S : Satisfactory
NS : Non Satisfactory

Inspected by,
( )
 MIT-F06-01-02-06H
Revisi 03
8/24/2017

CHECK LIST OF SAFETY DEVICE

FOR STORAGE TANK
EXISTING INSTALASI

Remarks
 PT. MARKA INSPEKTINDO TECHNICAL

(MARINDOTECH)
CHECK LIST OF SAFETY DEVICE
FOR PROCESS PIPING
EXISTING INSTALASI
Report No :
Owner :
User :
Date Of Inspection :
Location :
Line No / Indentifications :
Size :
P & ID :
Services :
Material Specification :
Year Built / Year Used :
Code / Standard :

Condition
No. Descriptions Remarks
S/NS
1 Pipe Support
2 Bolt & Nut Condition
3 Gasket
4 Flange
5 Pressure Indicator
6 Temperature Indicator
7 Safety Instrument
8 Bonding
9 Insulation
10 Painting
11 Coating
S : Satisfactory
NS : Not Satisfactory

Inspected by :

( )
 MIT-F06-01-02-06I
Revisi 03
24/08/2017
E

Remarks
 MIT-F06-01-02-06L
PT. MARKA INSPEKTINDO TECHNICAL
Revisi 03
8/24/2017
(MARINDOTECH)
CHECK LIST OF SAFETY DEVICE
FOR OVERHEAD CRANE
EXISTING INSTALASI
Report No. :
Owner :
User :
Date Of Inspection :
Location :
Tag. No / Serial No. : /
Type/Jenis : /
Capacity :
Manufacture :
SKPP Migas No. :

Condition
No. Descriptions Remarks
S/NS
1 Name Plate
2 Load Indicator
3 Overload Protection
4. Hoist Limit Switch
5. Travelling & Traversing Limit Switch
6. Travelling & Traversing Stopper/Bumper
7. Alarm/Signal Horn
8. Automatic Brakes
9. Painting
10. Insulation
11. Bolt & Nut
12. Ladder, Walkway, Platform
13. APAR
14. Warning Lamp
S : Satisfactory
NS : Not Satisfactory

Inspected by :

( )
MIT-F06-01-02-06L
Revisi 03
8/24/2017

Remarks
 MIT-F06-01-02-06K
PT. MARKA INSPEKTINDO TECHNICAL
Revisi 03
8/24/2017
(MARINDOTECH)
SAFETY DEVICE CHECKLIST
FOR MOBILE CRANE
EXISTING INSTALASI
Report No. :
Owner :
User :
Date Of Inspecton :
Location :
Tag. No./Serial No. :
Type / Jenis :
Capacity :
Manufacturer :
SKPP Migas No. :

Condition
No. Description Remarks
S/NS
1 Name Plate
2 Instrument Panel
3 Boom Hoist Limit
4 Boom Back Stop
5 Anti Two Block
6 Load Indicator
7 Boom Angle Indicator
8 Radius Indicator
9 Emergency Shutoff
10 Overload Protection
11 Prime Mover Start and Stop
12 Outrigger Condition
13 Horn
14 Automatic Brakes
15 Painting
16 Insulation
17 Bolt & Nut
18 Ladder, Walkway, Platform

S : Satisfactory
NS : Not Satisfactory

Inspected by :
( )
MIT-F06-01-02-06K
Revisi 03
8/24/2017

Remarks