Form: Crane Monthly Inspection ‘SAFETY INSPECTION CHECK LIST Ref no : Crane Inspection Monthly cheeklist Date: 01/10/09 Rev no 0 Project Site Date of Inspection Contractor Location of Inspection Type of Crane MACHINE MODEL OWNER SERIAL NO, LOCATION ENG MAKE USER ENG_NO. INSPECTOR HOURS DATE YEAR OF MFG INITIAL TYPE OF CRANE tick mark the box PEDESTAL CRAWLER | HYDRAULIC TRUCK_[ ROU H TERRAIN BOOM LENGTH MAX. CAP. MAIN Holst MAX, CAP_AUX nolst MAX. CAP, MAIN@® RAD. MAX CAP_AUX @ RAD. DESCRIPTION NO. | CERTIFICATES Crane o1_| micas 02 | Crane Bid Party 03_| Boom Hoist Wire Rope STATUS REMARKS/RECOMMENDATIONS 04_| Main Block Wire Rope (05_| Aux. Block Wire Rope (06 | Operator's license CRANE LOG BOOK (07 _| Daily inspection Cheek 08 _| We« ly Wire Rope Check (09_| Weekly Safety Device Test 10_| Limit Switches/Load Indicator T1_| Weekly Boom Visual 12_| Mainten nce Schedule ~13 | Replacement/Repair RecordSupervisors Signature MANUALS/PROCEDURES 15_| Operating Manual 16 | Operating Procedure 17 | Bherpecy Poced MARKINGS TS | SWE Marking 19 | Colour Ci 20_| Sign Board ANNUAL MPLTEST | Main Block Hook 22 Aun Block Hook 23 | Boom Lacing wo, | BESCRIPTION aceerrante | soon neptack | REMARKS UPPER STRUCTURE 24_[ Overall Condition 25 Paint Condon 26 | Mast Condition 27_[ Boom Backsiop 28[ Counterweight 29, | Pendants/Links 30 | Sheaves Bearings Bushing 33 | Condition A-frame [roweK rant 34|Constion of Bets 35_| Condition of Radiator 36_[PipingHoses 38 [ Any leakage 39 _[Rngine tempore 40_| Engine oil pressure 41 | Governor option 43_| Condition of e 44_| ESD System 45_| Oil Pressure Gauge 46_| Water Temperature Gauge 7 Air Pressure Gauge CONVERTER(Converter condition | Control linkages/pins 50_| Pipingyhaseseonition S| Chics MAIN DRIVE 53_| Drum condition S4_| Clutch lini _ —_ _ - 35 onto! nkagesipins 56_| Rotating joint | Shoe? Drum clearance (clutch) Travel brakes INDEPENDENT SWING (@0_| Gear/Pinion condition 61_| Drum condition @2_| Clutch fining 63_| Control Linkagesiping/pins 4_| Rotating joint 65__| Swing brake lini (66_| Swing lock, functional 67_| Clutch clearance ACCEPTABLE, No, | DESCRIPTION ConpiTion | Poor REPLACE REMARKS conprmion _| coNpITiON BOOM HOIST GeariPinion condition [Auto brake ‘Aux. Brake Rotating joint Tinkages/pins/Pins Clutch clearance Boom hoist pawl Wire rope condition Leakages? [FRONT DRUM (HOIST) GeariPinion condition Drum condition Brake lining Brake clearance (Clute Ti (Clutch clearance | Rotating joint Tinkages/pins/PinsWire rope condition | REAR DRUM (HOIST) 36_[ Gear Pinion condition 37 [ Drum condition 38_| Brake Inng $9 | Brake clearance 90 Chute ining [Tot cht clearance — 92 Rovating joint 93 | Hinkages ins Pins 04 [ Wire ope conto [CONTROLS AND VALVES 35_[ Condon uetonal of valves 97 | Ryarutic leakages? 98 [Hydraulic hasesiping condon 99 [linkages in Pins 100-[ Wiperter TO1 | Brakes'Ciuth pedal ROTATING BED/CAR BODY TO? | House role, bushing & bearing TOS | ook oles basing & beat 104 | Condition of ler pth 105 | Travel bake 106 | Pan cover 107 | Linkages Ping Bois in Bot HYDRAULIC SYSTEM TO8_| Condition hyeraule pumps 109 | Condon swing motor 111 | Condition aux. Hoist motor 112 | Leaks on pump sais 113 [ Leaks on moor seals No, | DESCRIPTION ACCEPTABLE | POOR REPLACE, REMARKS CONDITION coxpimion_| conpmion CRAWLER 114 | Drive chain conditionitension TIS _| Sprocket condition 116 | Intermediate ole 117 [rele 118 | Crawler fame 119-[ Track condiioninson 120 Track pin conditionELECTRICAL SYSTEM 12 Alternator/Generator charg ‘Wiring condition on engine/panel All gauges on panel, functional 124 | Starr condition 125 | Swing Ligh & Alam 126 | Crane Reversing Light & Alama 127 | Flectial switches [CABIN 138 | Safety glans 129"[ Seat and cushion 130"| Doorsvindow IBL_| Reversing Mirror 132 | Main Hoist Dum Mion 135 | Fie Figg Equipment 134_[ Condition window wipes LUBRICANT & COOLANT 35 Raditrcoolnt-inhibter B6 137 | Engine oil level/condition Hydraulic oil level/condition Bs Chain case oil leveV/eondition 139 1 | Rotating bed sump oil level 140 ‘Swing bevel gear case Accumulator pressure 142 | Greasing point-sheaves, rotating 143 | Parts, roller & ete SLI SYSTEM 144 | Anti-two block 145 | Load indicator/moment 146 | Angle indicator 147 | Length indicator 148 | Load chart MISCELLANEOUS 149 | Main Hook block 150_| Main Hook condition I51_| Aux. Hook block ‘Aux. Hook condition 153 | Safety Lateh 154 | Sheaves 155_| Bearing Bush 156 | Sockeviwedgesielips 157 | Gantry (A-frame) 158 | Boom Cylinder Bushing 159 | Rope Guide Rollers 160 | Boom Lattice/members (bracing|REMARKS/COMMENTS/ITEMS NOT MENTIONED ABOVE pected by CTR (HSE & Authorized Person) ‘Acknowledged by: PERTAMINA Name Name Name Position Position Position Sign Sign Sign Form: Crane Weekly InspectionSAFETY INSPECTION CHECK Refno:0 Project Site Date of Inspection [dentification(S/N) of erane Contractor Location of inspection NO | DESCRIPTION coop | FAIR | poor | NA | REMARKS T_| Operator certificate (SIO) 2 | Third party certificate (load testy 3_| MIGAS cenificate 4 | Wiper S| Hom 6 | ESD. system Hydraulic sysiem and hose condition 8_| Lightings 9 | Spark Arrestor (if use within DKP area) n (at counter weight) 12_[ Cabin condition 13_[ Load indicator T4_| Limit switeh 15_| Safety lateh 16_| Battery connection and it covered 17 | Engine and fuel sysiem (leaks) 18_| Tires condition 19_| Maintenance log book 20 _| Insulation of exhaust 21_| Electrical cable connection, isolation 22 | Load chart (in English’ Indonesian) SWL, radius, boom length (clearly marking) First aid kit 26 | Loe book 27_| Colour code 28 | TPEC - CGI inspection sticker Comments : Inspected by CTR (HISE & Authorized Person) Acknowledged by: PERTAMINA