Inspection Date :

TRUCK CRANE INSPECTION Capacity :

Contractor :
STANDARD User Dept :
(PER.05/MEN/1985 PESAWAT ANGKAT DAN ANGKUT) No Register :

INSPECTION METHOD INSPECTION

No INSPECTION ITEM STANDARDS REASON FOR NOT COMPLY
VISUAL FUNCTION RESULT
USER LEC
Common
1 General Condition Good ▪
Are inflated and free of excessive wear or damage.
2 Wheel Tire (ban) Nuts are tight (Bebas dari pemakaian berlebihan dan ▪
kerusakan kempes dan rusak.baut rapat, roda depan
bukan vulkanisir)
3 Fuel tank cover (tutup bahan bakar) Tight,manufacturing standard (rapat,standard ▪
Fuel tank (tangki bahan bakar) pabrikan)
No leak (tidak bocor)
4 ▪
Cover all surface,isolator matrial (menutupi seluruh
5 Battery cover (tutup accu) permukaan,terbuat dari bahan isolator) ▪

6 Rearview mirror (kaca spion) Clearly (jelas) ▪

7 Horn (klakson) Work (berfungsi) ▪

Easy start and stop, no spark (mudah dihidup dan

8 Engine (mesin) matikan,tidak ada ▪
Brake Parking brake (rem, rem percikan)
9 parkir/rem tangan) Work (berfungsi) ▪

10 Headlamp (lampu utama) Signal Work (berfungsi) `

▪
lamp (lampu sein)
11 Radiator Above min. level (diatas ambang batas min) ▪
Gauge indicator cabin (panel
12 Work (berfungsi) ▪
indikator kabin)
13 Wiper Work (berfungsi) ▪
14 License of driver (SIM) Valid (min.B2) ▪
Special Requirement
1 Hydroulic system (sistem hidrolik) No leak,work and smothly (tidak bocor,berfungsi dan ▪
lancar)

2 Oil hydraulic (oli hirolik) Above min.level (diatas ambang batas min) ▪
Work,greased,safety lack work,not crack,bent
3 Hook (gantungan) and safety latch (berfungsi,greasing,safty lacknya berfungsi,tidak ▪
retak,bengkok)

4 Outrigger condition and completed No Crack and no leak (tidak ada retak dan bocor)
with base plate Base plate available
5 Wire condition and drum No damage (tidak rusak) ▪
6 Anti Two block Works (berfungsi) ▪
7 Fire extinguisher (APAR) Still segel and not expired (tersegel dan tidak ▪
kadaluarsa)
8 Boom Condition No crack ▪
9 Certificate SILO crane truck
SILO Masih Berlaku ▪
(sertifikat perlatan)

PASSED

HOLD

REJECTED

DURATION INSPECTION FROM: TO

SPECIAL NOTE:

INSPECTION BY APPROVED BY

Name and Signature Name and Signature