FORM SCRUT JELAJAH JAWA SELATAN

PAGE 1 OF 3
MECHANICAL AND CLASS SPECIFICATION

CAR REG NUMBER DRIVER NAME

VEHICLE BRAND AND TYPE CO-DRIVER NAME

VEHICLE DETAILS PASS FAIL VEHICLE DETAILS PASS FAIL

REGRITRASION VALIDATION ACTUAL ENGINE CC
LETTER OF STATEMENT FEUL PETROL/DIESEL
INSURANCE BODY
VALID DRIVING LICENSE CHASIS
DRIVER AXLE

BODY PASS FAIL ENGINE BAY PASS FAIL

BODY LIFT (MAX 100 MM) SNORKEL
BODY CONDITION BATTERY SECURE
SEAT MOUNTING FEUL LINE/HOSE
SEAT BELT (MIN 3 POINTS) FEUL TANK (S)
ROOF RACK (MAX 100 KG) OIL LEAK
EXHAUST
PROTECTION PASS FAIL
ROOL BAR BRAKE PASS FAIL
CARGO BARRIER CONDITION
LOOSE OBJECTS (must be securely mounted) PEDAL HEIGHT

ELECTRICAL PASS FAIL STEERING PASS FAIL

HEAD LIGHT STEERING PLAY
SPOT LIGHT WHEEL BEARINGS
TAIL LIGHT LINK AND BALL JOINTS
REVERSE LIGHT
TURN INDICATOR SUSPENSION PASS FAIL
HORN SHACKLES / U-BOLTS
WIPER BUSHING
CABLE & WIRING SHOCK ABSORBERS
ALTERNATOR minimum 100 Amp
BATTERY Minimum 2 Unit
min. 60 Ah 650 CCA
 PAGE 2 OF 3
MECHANIKAL AND RECOVERY

RECOVERY POINTS PASS FAIL RECOVERY GEAR PASS FAIL

FRONT
LOAD RATING & MOUNTING
REAR
LOAD RATING & MOUNTING
ELECTRIC WINCH (FRONT)
8274 MODEL OR SIMILAR
WINCH MOUNTING
CRIMPED CABLE LOOPS
STEEL AIRCRAFT CABLE OR-
WINCH PLASMA ROPE
CABLE/ROPE CONDITION
NO BROKEN STRANDS
NO CRUSHED SECTIONS
NO KINKED SECTIONS
ELECTRIC WINCH (REAR)
MINIMUM 8000 LBS
WINCH MOUNTING
CRIMPED CABLE LOOPS
STEEL AIRCRAFT CABLE OR-
WINCH PLASMA ROPE
CABLE/ROPE CONDITION
NO BROKEN STRANDS
NO CRUSHED SECTIONS
NO KINKED SECTIONS
WHEELS AND TIRES
MAX TIRE SIZE (37 X 12.5 )
WHEEL NUTS (NOTS MISSING )
TREAD DEPTH (MIN 80%)
SPARE TIRE
FLARES
2 X 3.25T SHACKLES (OMEGA/BOW SHACKLE)
1 X 3 inchi TREE TRUNK PROTECTOR
5 cm X 2.4 m,6.5 Ton
1 X 6 m STRAP FORM SCRUT JELAJAH JAWA SE
5 cm X 9 m,6.5 Ton
PASS FAIL 1 X 20 M EXTENSION STRAP / TEAM
5.5 cm X 20 m,4.5 Ton/PLASMA 11-13 mm
NO STIFF
NO DAMAGED SECTION
NO DAMAGED STITCHING
NO BROKES EYES
1 SNATCH BLOCK 7 TON
2 PAIR GLOVES (leather cut-resistant)
GROUND ANCHOR 1 / TEAM
BOOTS (covering ankle) 1pair/person
1 WINCH BLANKET (DAMPENER ) 1Kg
PASS FAIL
SPARE PARTS PASS FAIL
SPARE WINCH CABLE/ROPE
SPARE WINCH MOTOR
SPARE WINCH COUPLING
SPARE WINCH CLUTCH KIT
SPARE WINCH TOP HOUSING
SPARE MOTOR CABLE
SPARE SOLENOID
COMMUNICATION PASS FAIL
PASS FAIL VHF RADIO /RID
GPS- GARMIN 62 Series o better

LIFT JACK PASS FAIL

MOUNTING LOCATION
JACK BASE
SHOVEL min holder length 80cm
 PAGE 3 OF 3
COMPULSARY EQUIPMENT

COMPULSARY ITEMS PASS FAIL COMPULSAY ITEMS PASS FAIL

20 L WATER FIRE EXTINGUISHER 2 KG
20 JERRY CAN SPARE FEUL FIRST AID KID
NON PERISHABLE FOOD FLASH LIGHT (2PCS)
COOKING STOVE RULE BOOK
CUTLERY CONTROL CARD
TRASHBAG 1/DAY ROUTE BOOK
TENT OR CAMPING TRAP
FLYSHEET / TERPAULINE 4X3 M
VELBED / SLEEPING BAG
PERSONAL CLOTHING EVENT STICKER PASS FAIL
PERSONAL MEDICAL KIT WICDSCREEN
DOOR L/R
TOOL KIT COMPLETE REAR NUMBER
AIR COMPRESSOR SPONSOR
FAN BELT 1 SET
RADIATOR HOSES 1 SET
FEUL FILTER 1 pcs
ENGINE OIL
GEAR OIL
BRAKE FLUID
POWER STEERING FLUID
TEST RESULT PASS FAIL
REVERSE LIGHTS
TEST RESULT PASS FAIL TURN SIGNAL LIGHTS
VEHICLE COLOR HORN
WINCH TIE-ROD
BRAKE ROLLCAGE (SOFT TOP )
HEAD LIGHTS METAL PLATE ROOF COVER
BRAKE LIGHTS (SOFT TOP VEHICLE)
FEUL TANK CAP
SCRUTINEER
PASS / FAIL

DATE
SCRUTINEER

TIME
 JELAJAH JAWA SELATAN
6,7 & 8 SEPTEMBER 2019

Sekretariat : Optik Mandiri No 48 Cilacap,Hp,0851 0

FORM SCRUT JELAJAH JAWA SEL

MECHANICAL AND CLASS SPECIFICATION

CAR REG NUMBER

VEHICLE BRAND AND TYPE

VEHICLE DETAILS PASS

REGRITRASION VALIDATION

LETTER OF STATEMENT

INSURANCE

VALID DRIVING LICENSE

DRIVER

BODY PASS

BODY LIFT (MAX 100 MM)

BODY CONDITION

SEAT MOUNTING

SEAT BELT (MIN 3 POINTS)

ROOF RACK (MAX 100 KG)

PROTECTION PASS

ROOL BAR

CARGO BARRIER

LOOSE OBJECTS (must be securely mounted)

ELECTRICAL PASS

HEAD LIGHT

SPOT LIGHT

TAIL LIGHT

REVERSE LIGHT

TURN INDICATOR

HORN

WIPER

CABLE & WIRING

ALTERNATOR minimum 100 Amp

BATTERY Minimum 2 Unit

min. 60 Ah 650 CCA

FORM S
 MECHANIKAL AND RECOVERY

RECOVERY POINTS PASS

FRONT

LOAD RATING & MOUNTING

REAR

LOAD RATING & MOUNTING

ELECTRIC WINCH (FRONT) PASS

8274 MODEL OR SIMILAR

WINCH MOUNTING

CRIMPED CABLE LOOPS

STEEL AIRCRAFT CABLE OR-

WINCH PLASMA ROPE

CABLE/ROPE CONDITION

NO BROKEN STRANDS

NO CRUSHED SECTIONS

NO KINKED SECTIONS

ELECTRIC WINCH (REAR) PASS

MINIMUM 8000 LBS

WINCH MOUNTING

CRIMPED CABLE LOOPS

STEEL AIRCRAFT CABLE OR-

WINCH PLASMA ROPE

CABLE/ROPE CONDITION
NO BROKEN STRANDS

NO CRUSHED SECTIONS

NO KINKED SECTIONS

WHEELS AND TIRES PASS

MAX TIRE SIZE (37 X 12.5 )

WHEEL NUTS (NOTS MISSING )

TREAD DEPTH (MIN 80%)

SPARE TIRE

FLARES

LIFT JACK PASS

MOUNTING LOCATION

JACK BASE

SHOVEL min holder length 80cm

COMPULSARY EQUIPMENT

COMPULSARY ITEMS PASS

20 L WATER

20 JERRY CAN SPARE FEUL

NON PERISHABLE FOOD

COOKING STOVE

CUTLERY

TRASHBAG 1/DAY

TENT OR CAMPING TRAP

FLYSHEET / TERPAULINE 4X3 M

VELBED / SLEEPING BAG

PERSONAL CLOTHING

PERSONAL MEDICAL KIT

TOOL KIT COMPLETE

AIR COMPRESSOR

FAN BELT 1 SET

RADIATOR HOSES 1 SET

FEUL FILTER 1 pcs

ENGINE OIL

GEAR OIL

BRAKE FLUID

POWER STEERING FLUID

TEST RESULT PASS

VEHICLE COLOR

WINCH

BRAKE

HEAD LIGHTS

BRAKE LIGHTS

SCRUTINEER

SCRUTINEER
A SELATAN
BER 2019

ilacap,Hp,0851 0751 5800

H JAWA SELATAN
PAGE 1 OF 3

DRIVER NAME

CO-DRIVER NAME

FAIL VEHICLE DETAILS PASS FAIL

ACTUAL ENGINE CC

FEUL PETROL/DIESEL

BODY

CHASIS

AXLE

FAIL ENGINE BAY PASS FAIL

SNORKEL

BATTERY SECURE

FEUL LINE/HOSE

FEUL TANK (S)

 OIL LEAK

EXHAUST

FAIL

BRAKE PASS FAIL

CONDITION

PEDAL HEIGHT

FAIL STEERING PASS FAIL

STEERING PLAY

WHEEL BEARINGS

LINK AND BALL JOINTS

SUSPENSION PASS FAIL

SHACKLES / U-BOLTS

BUSHING

SHOCK ABSORBERS

FORM SCRUT JELAJAH JAWA SELATAN

 PAGE 2 OF 3

FAIL RECOVERY GEAR PASS FAIL

2 X 3.25T SHACKLES (OMEGA/BOW SHACKLE)

1 X 3 inchi TREE TRUNK PROTECTOR

5 cm X 2.4 m,6.5 Ton

1 X 6 m STRAP

5 cm X 9 m,6.5 Ton

FAIL 1 X 20 M EXTENSION STRAP / TEAM

5.5 cm X 20 m,4.5 Ton/PLASMA 11-13 mm

NO STIFF

NO DAMAGED SECTION

NO DAMAGED STITCHING

NO BROKES EYES

1 SNATCH BLOCK 7 TON

2 PAIR GLOVES (leather cut-resistant)

GROUND ANCHOR 1 / TEAM

BOOTS (covering ankle) 1pair/person

1 WINCH BLANKET (DAMPENER ) 1Kg

FAIL

SPARE PARTS PASS FAIL

SPARE WINCH CABLE/ROPE

SPARE WINCH MOTOR

SPARE WINCH COUPLING

SPARE WINCH CLUTCH KIT

SPARE WINCH TOP HOUSING

 SPARE MOTOR CABLE

SPARE SOLENOID

COMMUNICATION PASS FAIL

FAIL VHF RADIO /RID

GPS- GARMIN 62 Series o better

FAIL

FORM SCRUT JELAJAH JAWA SELATAN

 PAGE 3 OF 3

FAIL COMPULSAY ITEMS PASS FAIL

FIRE EXTINGUISHER 2 KG

FIRST AID KID

FLASH LIGHT (2PCS)

RULE BOOK

CONTROL CARD

ROUTE BOOK

EVENT STICKER PASS FAIL

WICDSCREEN

DOOR L/R

REAR NUMBER

SPONSOR

TEST RESULT PASS FAIL

 REVERSE LIGHTS

FAIL TURN SIGNAL LIGHTS

HORN

TIE-ROD

ROLLCAGE (SOFT TOP )

METAL PLATE ROOF COVER

(SOFT TOP VEHICLE)

FEUL TANK CAP

PASS / FAIL

DATE

TIME