Form No. S.2.2.

016/FRM
Contractor & Mining Developer Rev : 00
KPP

(QA 7 & QA 1) MACHINE INSPECTION REPORT

MACHINE WHEN INSPECTED

MODEL CODE NUMBER DATE HOUR METER
CONDITION MANITOU
CB0006
QA 7 QA 1 REMARKS
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 blade,Pulley,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 Lubrication oil Oil level
Lubricating oil piping and hose Connection and mounting
TRANSMISSION &
CLUTCH SYSTEM

2
3 Transmission and mounting bolt Connection and mounting
4 Trans.air control and tube Connection and mounting
5 Universal joint and mounting bolt Connection and mounting
6 Performance test Unusual noise and leak
7 Seal input and out put shaft Leak,loose
8 Propeler shaft mounting bolt Loose,no lub,unusual noise
1 Lubrication oil Level,Deterioration
2 Hydraulic tank and mounting bolt Leak,loose,crack
HYDRAULIC

3 valve,cylinder and mounting bolt Leak,loose,crack,mulfunction

SYSTEM

4 cyl.piping and hose Leak,loose,crack,mulfunction

5 Pump,piping hose and mounting bolt Leak,loose,crack,mulfunction
6 Performance test Unusual noise,knocking,Low power
7 Pump and connection hose Oil leak,loose,crack,mulfunction
1 Steering valve,hose and mounting bolt Leak,loose,crack,mulfunction
STEERING
SYSTEM

2 Steering cyl.,and piping Leak,loose,crack,mulfunction

3 Steering wheel end ply Small,Large
4 lubrication oil Level,deterioration
1 Lubrication oil Level,deterioration
2 Differential oil seal Leak,loose,crack,unusual noise
BRAKE SYSTEM
FINAL DRIVE &

3 Drive shaft,spider joint and mounting bolt Crack,band,loose,broken,no lub

4 Torque rod,pin and bushing Crack,band,loose,broken
5 Rear and Brake chamber Leak,worn,crack Mulfunction
6 Front and brake chamber Leak,worn,crack Mulfunction
7 Knuckle ,Tie rod,bushing and pin Crack,band,loose,broken,no lub
8 F/D housing,Cover and mounting bolt Leak,loose,crack,unusual noise
9 Performance test Unusual noise,knocking,Low power
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,buzzer,horn,switch Damage,mulfunction
7 Warning lamp,working lamp,turn lamp,brake lamp,Rotary lamp Damage,mulfunction
8 E/g controler,T/M controler Damage,mulfunction
1 APAR Leak,Loose,Broken
OTHERS

2 Radio & PTT Loose,Broken,Mulfunction

3 Tire and mounting Nut Worn,loose,broken
Mechanic comment :

V : Good Condition
Notes :

Approved by, Inspected QA 7 by, Inspected QA 1 by,

X : Bad Condition
( ) ( ) ( )
NA: Not Aplicable G.Leader Mechanic Mechanic
REVISI : 0 Page 1 / 6
 Form No. S.2.2.016/FRM
Contractor & Mining Developer
KPP
Rev : 00

PERIODICAL SERVICE FORM

MANITOU
UNIT MODEL: MT1340, MT1440
ENGINE MODEL:
CODE NUMBER: CB0006
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 )

ENGINE OIL (QTY BOTTLE)

PAP SAMPLE

ANGLE GEAR BOX (QTY BOTTLE)

Mechanic
TRANSMISSION OIL (QTY BOTTLE)

DIFFERENTIAL (QTY BOTTLE)

FINAL DRIVE OIL (QTY BOTTLE)

HYDRAULIC 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 CABIN WARNING LAMP & BUZZER RECHECK

9 START ENGINE, CHECK NOISE RECHECK

10 WORKLAMP, TURN LAMP, SIGNAL LAMP RECHECK

11 WORK EQUIPMENT FUNCTION RECHECK

12 BRAKE FUNCTION RECHECK

13 TRAVEL FUNCTION RECHECK

14 OIL/WATER/FUEL LEAKAGE RECHECK

NAME

SIGN
Page 2 / 6
 Form No. S.2.2.016/FRM
Contractor & Mining Developer Rev : 00
KPP

PERIODICAL SERVICE FORM

MANITOU
UNIT MODEL: MT1340, MT1440
HM
CODE NUMBER: CB0006 Mech.
EVERY 250 HOURS ACTIVITY STD. PS I PS II PS III PS IV PIC
1 ENGINE OIL CHANGE 20
2 OIL FILTER REPLACE 10

3 FUEL FILTER REPLACE 10

4 RADIATOR COOLANT CHECK BY C / TESTER 5

5 OUTER AIR CLEANER CLEAN 15

6 DUST INDICATOR CHECK 3

7 EXHAUST SYSTEM LEAKAGE & CLAMP CHECK & REPAIR 5

8 ENGINE RUBBER MOUNTING FOR TIGHTNESS CHECK & RETIGHTEN 5

9 FAN BELT TENSION INSPECT & ADJUST 5

10 V-BELT ALTERNATOR INSPECT & ADJUST 5

11 V-BELT AC COMPRESSOR INSPECT & ADJUST 5

12 ENGINE BREATHER CHECK 3

13 ENGINE CYLINDER HEAD COVER CHECK 5

14 JIB PADS LUBRICATE 3

15 CAB DOOR LUBRICATE 3

16 FRONT WHEEL REDUCERS PIVOT LUBRICATE 3

MECHANIC
17 REAR WHEEL REDUCERS PIVOT LUBRICATE 3

18 FRONT AXLE OSCILLATION LUBRICATE 3

19 REAR AXLE OSCILLATION LUBRICATE 3

20 TRANSMISSION UNIVERSAL JOINT LUBRICATE 3

21 TILTING CORRECTOR LUBRICATE 3

22 STABILIZERS LUBRICATE 3

23 BRAKE SYSTEM CHECK & ADJUST 5

24 PARKING BRAKE CHECK & ADJUST 5

25 WINSHILD WIPPER INSPECT 5

26 WHEEL NUTS TORQUE CHECK/RETORQUE 15

STARTING AND CHARGING SYSTEM

27 STARTING MOTOR CHECK FUNCTION 15

28 BATTERY ELECTROLITE CHECK AND REFILL 3

29 BATTERY TERMINAL CLEAN AND CHECK 3

30 ALTERNATOR CHECK FUNCTION 10

31 WIRING HARNESS , MONITOR PANEL CHECK AND REPAIR 5

32 LIGHTING SYSTEM (HEAD LAMP, TURN SIGNAL, WORK LAMP) CHECK FUNCTION 10

33 ROTARY LAMP CHECK FUNCTION 3

34 BACK UP ALARM CHECK FUNCTION 3

EVERY 500 HOURS ACTIVITY STD. PS I PS II PS III PS IV PIC

FUEL SYSTEM

35 FUEL LEAK AS PIPING,HOSES CHECK / REPAIR 15

AIR INTAKE & EXHAUST SYSTEM

36 AIR LINE FOR CLAMP & HOSE CHECK / REPAIR 5

37 TURBOCHARGER CHECK & REPLACE 5

38 AIR INTAKE & EXHAUST FOR LEAKS CHECK / REPAIR 5

MECHANIC

39 MUFFLER BRACKET & CLAMP CHECK & RETORQUE 5

COOLING SYSTEM

40 WATER LINE FOR HOSE, PIPE & CLAMP CHECK/REPAIR AND REPLACE 5

41 RADIATOR CORE CLEAN AND CHECK 10

42 RADIATOR MOUNTING FOR TIGHTNES CHECK 3

43 FAN GUARD CHECK 3

44 WATER PUMP CHECK / REPLACE 15

4.60

START

STOP
V Kotak checkmark sebagai tanda bahwa recheck telah dilakukan untuk critical item Page 3 / 6
 Form No. S.2.2.016/FRM
Contractor & Mining Developer
KPP
Rev : 00

PERIODICAL SERVICE FORM

MANITOU
UNIT MODEL: MT1340, MT1440

INSPECTION REPORT CODE NUMBER: CB0006

Part Number No. Inspection Plan Repair Plan Repair Status
No HM Problem Description Component Part Description No. Figure Qty
Required Index Date Date Duration (Hour) (BL/Close)

Page 4 / 6
 Form No. S.2.2.016/FRM
Contractor & Mining Developer Rev : 00
KPP

PERIODICAL SERVICE FORM

MANITOU
UNIT MODEL: MT1340, MT1440
HM
CODE NUMBER: CB0006 Mech.
EVERY 500 HOURS ACTIVITY STD. PS I PS II PS III PS IV PIC
46 FRONT AND REAR AXLE DIFFERENTIAL OIL CHANGE 30

MECHANIC
47 TRANSMISSION OIL FILTER REPLACE 10

48 HYDRAULIC RETURN OIL FILTER CARTRIDGE REPLACE 10

49 HYDRAULIC BREATHER CHECK 5

50 PARKING BRAKE LEVER MECHANISM LUBRICATE 3

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

51 OUTER AIR CLEANER REPLACE 5

52 RADIATOR MOUNTING FOR TIGHTNESS CHECK & RETORQUE 5

53 FRONT AND REAR FINAL DRIVE OIL CHANGE 30

MECHANIC
54 FILTER CAP FOR HYD OIL TANK CHECK 10

55 SUCTION STRAINER FOR HYDRAULIC OIL TANK CLEAN 15

56 TRANSMISSION OIL CHANGE 10

57 ANGLE GEAR BOX OIL CHANGE 15

58 BLEED THE BRAKE CIRCUIT BLEED & CHANGE 15

EVERY 2000 HOURS ACTIVITY STD. PS I PS II PS III PS IV PIC

MECH
59 WATER COOLANT CHANGE 15

60 AIR CLEANER INNER REPLACE 5

3.05

START

STOP

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

Page 5 / 6
 Form No. S.2.2.016/FRM
Rev : 00
Contractor & Mining Developer
KPP

PERIODICAL SERVICE FORM

MANITOU
UNIT MODEL: MT1340, MT1440

INSPECTION REPORT CODE NUMBER: CB0006

Part Number No. Inspection Plan Repair Plan Repair Status
No HM Problem Description Component Part Description No. Figure Qty
Required Index Date Date Duration (Hour) (BL/Close)
Page 6 / 6
 Status
(BL/Close)
Page 6 / 6