PT.

WIRANA NUSANTARA ENERGY

PRE - TRIP INSPECTION FOR VEHICLE

No. Kendaraan / Vehicle Number : Hari / tanggal / Day / date :

Dept. / Pengguna / Dept. / User : Lokasi / Location :

Bagian yang Diperiksa Bagus Rusak Keterangan
No.
Inspected items Good Broken Remark

Kondisi Keselamatan Utama / Primary Safety Condition

1 Sabuk pengaman ( pengemudi & penumpang ) Safety belts ( driver & passenger )
2 Lampu depan, belakang, & tanda berbelok Head / rear lights & turn signals
3 Rem utama dan lampu rem Main brake and lights
4 Rem & lampu parkir Parking brake & lamps
5 Klakson & alarm mundur Horn & reverse alarm
6 Spion, kaca depan & penghapus air Side mirrors, windscreen & wipers
7 Pengukur jarak & kecepatan Odometer & speedometer
8 Pengunci pintu Door locks
9 Kondisi ban Tire conditions
10 Tekanan ban & kondisi roda (baut-baut ) Tire pressure & wheel conditions ( bolt )

Kondisi Keselamatan Tambahan / Additional Safety Condition

11 Tabung pemadam kebakaran Fire extinguisher cylinder
12 Kotak P3K First aid kit
13 Dongkrak & peralatan standard Jack & basic toolkit
14 Segitiga pengaman Safety triangle
15 Sabuk pengaman penumpang baris berikutnya Safety belts for other rows passenger
16 STNK dan buku Kir ( bila diperlukan ) Vehicle documents
17 Kaca samping Door & side glasses
18 Ban cadangan Spare tire

Kondisi Mesin dan Mekanis / Engine & Mechanical Conditions

19 Minyak mesin Engine oil
20 Minyak transmisi Transmission oil
21 Minyak power steering Power steering oil
22 Rem & cairan rem Brake & Brake fluid
23 Air radiator Radiator fluid
24 Aki & air aki Battery & battery fluid
25 Pengatur suhu / Pendingin ruangan ( AC ) Air Conditioner ( AC )

Catatan / Note : Segera melapor ke Supervisor jika ada bagian-bagian yang tidak berfungsi dengan baik atau rusak
Report to Supervisor immediately if some items / parts are not in good condition or broken.

Pengemudi / Driver Supervisor

Nama / Name Nama / Name

Dept. Dept.

Tanda tangan / Signature Tanda tangan/Signature

Catatan kepada mekanik / Note to mechanic