Checklist Forklift

Nama Forklift (Forklift Name) : ___

GG-FL-01 Note : (Ö) kondisi bagus (Good)
Periode (Periode) : _______________________________ (X) kondisi rusak (Bad)
Sub. Dept. Head : _______________________________ (n/a) not available

Kondisi per-hari (Daily Condition)

No. Bagian (Section)
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

1 Level oli hydraulic (Hydraulic Oil Level)

2 Level oli rem (Brake Oil Level)

3 Indicator Battery (Battery Indicator)

4 Shocket aman (Connector Securely)

5 Stick air accu pada batas normal (Stick

to Normal Condition)
Battery dalam kondisi bersih (Battery
6 Condition Clean)

7 Rem (Brake)

8 Hand rem (Parking Brake)

9 Rantai & Baut (Chains & Fixing Bolts)

10 Kemudi (Steering)

11 Ban (Tire)

12 Roda/velg (Wheel)

13 Kursi & Sabuk pengaman (Seat & Safety

Belt)

14 Lampu Sein & Mundur (Turn Signal &

Reverse Light)

15 Lampu Head (Head Lamp)

16 Bel (Horn)

17 Alarm mundur (Reverse Alarms)

18 Layar informasi (Mainboard Indicator)

19 Atap pengaman (Safety Guards)

20 Kaca spion (Spion Glass)

21 Garpu (Fork)

22 Kebersihan (Cleanliness)

23
Note :

Operator : Signature :

Safety officer : Signature :

 PEMERIKSAAN KENDARAAN SEBELUM OPERASI
LIGHT VEHICLE PRE-OPERATIONAL INSPECTION
Tahun/Year:
No ITEM - ITEM YANG DIPERIKSA HARIAN Tgl/bln dd/mm
Items to be inspected daily Jam/ hour
1 Pembacaan Km Odometer/Odometer Km reading
2 Kondisi badan kendaraan/Condition of body

3 Roda:tread,tekanan angin,velg,baut
Wheels:tire,tread,air pressure,rim,bolts,nuts
4 Kaca depan,jendela/Windshield,Window glasses
5 Kaca Spion/Mirrors
6 Kondisi:Knalpot,Radiator/Condition of:Exhaust,Radiator

7 Lampu depan,kabut,bahaya,rem,sen,belakang,mundur
Headlights,fog,hazard,brake,turnback,back-up lights

8 Lampu bar,strobe,buggy whip/laampu (bila ada)

Bar light,strobe,buggy whip & lamp(if available)
9 Alat pemadam api,dongkrak/ Fire Extinguisher,jack
10 Sabu pengaman/Sealt belts
11 Level bahan bakar & intrumen meteran lainnya
Faul gauge reading & other istruments
12 Klakson/Horn
13 Tes rem parkir/Parking brake testing
14 Tes rem kaki/ Service brake testing
15 Stang kemudi / Sterering wheel
16 Penyeka kaca & air / Wipers & Water

Nama Pengemudi & Paraf /Driver ID & Sign of

Minggu/week Minggu/week
No CATATAN KERUSAKAN Tgl/Bln ID Driver Tindakan
ITEM - ITEM YANG DIPERIKSA MINGGUAN Item Damage Record
Item to be Inspected weekly dd/mm Action
No
Baterai:level fluid,braket,kabel koneksi
17 Battery;Fluid level,brackets,cable connection
Level oli/cairan;Mesin,rem,kopling,steering,air radiator
18 Oil/fluid level;engine,brake,clutch,steering,cooling
19 Kebocoran;oli,fluid,air,bahan bakar Leaking of;Oil,fluid,water,fuel
20 Tali kipas,Alternator,Comperssor Fan belt,Alternator,Comperssor

Tgl Tgl
Nama Pengemudi & Paraf /Driver ID & Sign of Date Date

Nama Pengawas & Paraf /Supervisor ID & Sign of

Tgl
Date
Tgl
Date PM BERIKUTNYA / next PM KM