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DAILY INSPECTION EXCAVATOR

Equipt/Tag. No : Month : Operator Name :


Type : Location :
Merk : Subcont :
DAY
No Description
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
A. Engine and Accessories
1 Bucket & Garpu
2 Sambungan Silinder Bucket
3 Stick Sylinder
4 Boom Sylinders
5 Sisi Bawah Mesin
6 Body Keseluruhan
7 Track dan bagian-bagiannya
8 Tuas tangan dan kaki
9 Battery / Accu
10 Wiper
11 APAR
12 Pendingin Mesin / Engine Coolant
13 Filter Bahan Bakar
14 Filter Udara
15 Tangki Oli Hidrolik
16 Filter Oli Hidrolik
17 Radiator
18 Pendingin Oli Hidrolik
19 Kondensor AC
20 Lampu
21 Kaca Spion
22 P3K
23 Oli Mesin
24 Oli Swing Gear
25 Swing Pinion Grease
26 Tangki Bahan Bakar
27 Selang dan pipa-pipa
28 Seat Belt
29 Klakson
30 Monitor dan indikator
31 Tombol-tombol
B. Documents
1 SILO for Equipment
2 SIO Operator

Inspected By Acknowledged by Acknowledged by

Driver/Operator Site Engineer Safety Officer


INSPECTION REPORT EXCAVATOR
Equipt/Tag No. : Month :
Unit : Location :
Model : Subcont :
DAY
NO DESCRIPTION REMARKS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
A ENGINE
1 Bucket & Garpu
2 Sambungan Silinder Bucket
3 Stick Sylinder
4 Boom Sylinders
5 Sisi Bawah Mesin
6 Body Keseluruhan
7 Track dan bagian-bagiannya
8 Tuas tangan dan kaki
9 Battery / Accu
10 Wiper
11 APAR
12 Pendingin Mesin / Engine Coolant
13 Filter Bahan Bakar
14 Filter Udara
15 Tangki Oli Hidrolik
16 Filter Oli Hidrolik
17 Radiator
18 Pendingin Oli Hidrolik
19 Kondensor AC
20 Lampu
21 Kaca Spion
22 P3K
23 Oli Mesin
24 Oli Swing Gear
25 Swing Pinion Grease
26 Tangki Bahan Bakar
27 Selang
28 Seat Belt
29 Klakson
30 Monitor dan indikator
31 Tombol-tombol
B DOCUMENT / SURAT-SURAT
1 SILO for Equipment
2 SIO Operator Valid Date
C TANK & ACCESSORIES
1 Piping & Hoses
2 Main Hole / Valve
3 Flow Meter

Inspected by, Acknowledged by, Acknowledged by,

Note: If already completed, please be


signed by the Operator, Site Engineer and
Safety Officer
Driver/Operator Site Engineer Safety Officer

Page 1 of 3 Note: (√) it's ok, (x) need to corrective, (N/A) not applicable

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